Anesthesia in severe preeclampsia

Abstract

The word “Preeclampsia” is derived from the Greek word Eklampsis meaning “lightening” or “convulsions”. A pregnancy with preeclampsia whose hypertension has been treated ante partum generally present for delivery with contracted plasma volume, normal or increased cardiac output, vasoconstriction, and hyper dynamic left ventricular function. There may also be a coexisting left ventricular systolic and diastolic dysfunction. Other problems are increased airway edema, decreased glomerular filtration, platelet dysfunction, or a spectrum of hemostatic derangements (the exaggerated hypercoagulable state).1 In severe preeclampsia there is chronic placental hypo perfusion.2 The uteroplacental circulation is not auto regulated and the fetus may poorly tolerate any further decline in perfusion. Thus the primary peripartum goals in the severely preeclampsia parturient are the optimization of maternal blood pressure, cardiac output, and uteroplacental perfusion and the prevention of seizures and stroke. The main concerns to the anaesthetist are an edematous airway, dysfunction of the cardio respiratory system, dysfunction of cerebro-vascular system and the dysfunction of coagulation system.3