title: Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison.
abstract: In this prospective cohort study, we compared the incidence and severity of spinal anesthesia (SA)-associated hypotension in severely preeclamptic (n = 30) versus healthy (n = 30) parturients undergoing cesarean delivery. After the administration of IV fluids, SA was performed with hyperbaric 0.5% bupivacaine, sufentanil, and morphine. Blood pressure (BP) was recorded before and at 2-min intervals for 30 min after SA. Clinically significant hypotension was defined as the need for ephedrine (systolic BP decrease to <100 mm Hg in healthy parturients or 30% decrease in mean BP in both groups). Despite receiving a smaller fluid volume (1653 +/- 331 mL versus 1895 +/- 150 mL; P = 0.005) and a larger bupivacaine dose (10.5 +/- 0.9 mg versus 10.0 +/- 0.7 mg; P = 0.019), the severely preeclamptic patients had a less frequent incidence of clinically significant hypotension (16.6% versus 53.3%; P = 0.006), which was less severe and required less ephedrine. The risk of hypotension was almost six times less in severely preeclamptic patients (odds ratio, 0.17; 95% confidence interval, 0.05-0.58; P = 0.006) than that in healthy patients.
authors.affiliation: Division of Anesthesiology, Pain Management, Emergency and Critical Care Medicine, University Hospital, Nîmes, France.
authors.forename: Antoine G M
authors.initials: AGM
authors.lastname: Aya
authors.forename: Roseline
authors.initials: R
authors.lastname: Mangin
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vialles
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Ferrer
authors.forename: Colette
authors.initials: C
authors.lastname: Robert
authors.forename: Jacques
authors.initials: J
authors.lastname: Ripart
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology*; D007231:Infant, Newborn; D008278:Magnesium Sulfate / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D015149:Tocolytic Agents / Q000627:therapeutic use
chemical_list: D015149:Tocolytic Agents; D008278:Magnesium Sulfate