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CAESAREAN
SECTION IN PRE-ECLAMPSIA AND ECLAMPSIA
In all degrees of pre-eclampsia, spinal anaesthesia is preferable
to general anaesthesia because:
| :: |
It
causes vasodilatation |
| :: |
There
is no hypertensive response to intubation |
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There
is no need to manage a difficult airway. |
Clotting
studies may not be available but, if there are no reasons
to suspect abnormal clotting, the carefully executed spinal
using a 25G needle is the
method of choice in a cooperative patient.
Methods of general anaesthesia for caesarean section in pre-eclampsia vary.
Halothane is traditional. Ether releases adrenaline which, in theory, exacerbates
the condition but does not seem to do so in practice. As ether is generally
preferable to halothane for caesarean section, it is a good choice for general anaesthesia
in pre-eclampsia.
Never give ketamine in pre-eclampsia.
Potential problems with the induction of anaesthesia
| :: |
Conscious
level: sedative drugs may require a reduction in the
dose of induction agent |
| :: |
Difficult
airway due to oedema |
| :: |
Hypertensive
response to intubation |
| :: |
Difficult
intubation due to laryngeal oedema |
| :: |
Difficulties
measuring blood pressure due to the low volume state
and vasoconstriction. |
Patients should be monitored in the intensive care unit postoperatively,
with special emphasis on:
| :: |
Blood
pressure |
| :: |
Urine
output |
| :: |
Fluid
balance |
| :: |
Conscious
level |
| :: |
Airway
oedema. |
After eclampsia (fits), the management is similar to the above but general anaesthesia
must be used if the mother is unconscious. Pulmonary oedema
may be a problem, necessitating controlled ventilation. Eclamptic fits
must be controlled postoperatively. A bitten tongue may cause difficult
intubation.
After prolonged eclampsia, mothers are unconscious and in very poor condition.
Some surgeons opt for local infiltration anaesthesia of the abdominal wall
to perform caesarean section. This should not be allowed for two reasons.
| 1 |
Often
the analgesia is insufficient and the pain, even in
an unconscious patient, puts the blood pressure even
higher. |
| 2 |
Hypoxia
during the procedure is very likely and should be prevented
with intubation and ventilation with oxygen. |
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