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.