Management of Preeclampsia in Perioperative Conditions

Abstract

Anaesthetists are the key member of a multidisciplinary team providing management to a preeclamptic patient. Anaesthetist’s responsibility starts before the surgery at the moment of stabilising patient’s hemodynamic status and guiding to an obstetrician about administration of antihypertensives and seizure prophylaxis. Recent literature about antihypertensives and seizure prophylaxis is reviewed. Labetolol, hydralazine, diazoxide and nifedipine is considered as the most common used drugs and their dosage is revised in the light of the recent literatures. Magnesium sulphate is the most effective agent for seizure prophylaxis. Platelet transfusion threshold is determined as 50000/mm3 in acutely bleeding patient. We discussed the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia. We emphasized the difficulties encountered in general anesthesia. The benefits of neuroaxial anesthesia in labour are well established. Potential maternal life-threating complications include acute pulmonary edema, oliguria and acute renal failure, intracranial hemorrhagies and stroke and also the treatment options in intensive care unit at the postnatal period is summarized. Plasmapheresis is discussed as an alternative successful treatment option in preeclamptic patients whose platelet consumption persisted after delivery.