Comparison of hemodynamic response and vasopressor requirement following spinal anaesthesia between normotensive and severe preeclamptic women undergoing caesarean section: A prospective study

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Background: Spinal anesthesia is the technique of choice in cesarean sections, but it is not widely accepted in severe pre-eclampsia due to fear of sudden and extensive sympathetic blockade. The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), phenyl ephrine requirement, and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Materials and Methods: A total of 30 healthy (group 1) and 30 severe pre-eclamptic (BP > 160/110 mmHg) parturients (group 2) above 18 years of age, meeting inclusion criteria undergoing elective cesarean section, were included in the study. After preloading with 10 ml/kg of ringer lactate solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Also, SBP, DBP, MAP, and HR were recorded before spinal anesthesia and then at every 2-min interval after spinal block for the first 30 min and thereafter every 5 min until completion of surgery. Phenylephrine was administered in 50 μg bolus dose when MAP decreased below 30% of base line. Apgar score was noted 1 and 5 min after birth. Results: The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P < 0.0001) than that of pre-eclamptic group (48.3 ± 35). Apgar scores at 1 and 5 min after birth were comparable in both the groups.Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.