Describe the anesthetic options for cesarean section for the
preeclamptic patient.
Once the blood pressure is controlled and the
fluid status and coagulation parameters normalized, cesarean section can be
safely performed under epidural, spinal or general anesthesia. The advantage of
an epidural anesthetic over a spinal anesthetic is that the hemodynamic changes
are minimized because the anesthetic level can be raised slowly. Although a
spinal anesthetic is technically easier to perform and has a quicker onset than
an epidural anesthetic, the hemodynamic alterations may be more profound.
General anesthesia is often required for an emergency
cesarean section. Even in the presence of fetal distress, time should be taken
to adequately control the blood pressure prior to induction. This is because
laryngoscopy may cause a significant increase in blood pressure, which can lead
to cerebral hemorrhage. After preoxygenation, a rapid sequence induction with
thiopental, succinyl-choline, and cricoid pressure is performed. If the patient
is on MgSO4, succinylcholine and the nondepolarizing muscle
relaxants may have a prolonged duration of action. However, the dose of
succinylcholine should not be reduced since a fast onset of paralysis is
needed. A neuromuscular monitor should be used to guide subsequent doses of
mus-cle relaxants. An array of laryngoscopes, endotracheal tubes, combitubes,
and laryngeal mask airways should be available to deal with a potentially
difficult airway.
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