Sarcouncil Journal of Medical Sciences

Abstract: Background and Objectives: General anesthesia in preeclamptic patients presents substantial maternal risks due to airway edema, challenging intubation, and aggressive hypertensive responses during laryngoscopy. While neuraxial techniques are generally preferred, concerns historically existed regarding sudden sympathetic blockade and subsequent severe hypotension. This study aimed to compare the hemodynamic profiles, magnitude of blood pressure changes, and incidence of spinal anesthesia-associated hypotension between preeclamptic and healthy normotensive parturients undergoing cesarean sections. Patients and Methods: A prospective comparative study was conducted at Yarmouk Teaching Hospital involving 60 parturients scheduled for cesarean section under spinal anesthesia. The cohort was divided into two equal groups (n = 30 each): Group 1 consisting of healthy normotensive parturients (controls) and Group 2 consisting of patients diagnosed with preeclampsia. All patients received a standardized intravenous fluid co-load of 1500–2000 mL of Lactated Ringer's solution. Spinal anesthesia was administered in the sitting position using hyperbaric 0.5% bupivacaine (10–15 mg). Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at 2-minute intervals for the first 10 minutes and every 5 minutes thereafter. Clinically significant hypotension was managed with 5 mg intravenous ephedrine boluses. Results: Baseline SBP, DBP, and MAP were significantly higher in the preeclamptic group (p<0.001). Following the spinal block, significant decreases in SBP, DBP, and MAP were observed in both groups (p<0.001). However, the magnitude of the drop in blood pressure was significantly smaller, and the rate of decline was slower, in the preeclamptic group compared to the control group (p<0.001 for SBP and MAP; p<0.003 for DBP). Clinically relevant hypotension requiring rescue ephedrine therapy occurred in only 2 patients (6.6%) in the preeclamptic group, compared to 6 patients (20.0%) in the healthy control group. Baseline heart rate was higher in preeclamptic patients (p<0.001), whereas normotensive patients exhibited a more pronounced compensatory heart rate increase following the block. Conclusions: Preeclamptic patients exhibit greater hemodynamic stability and a significantly lower incidence of spinal anesthesia-induced hypotension during cesarean deliveries compared to healthy normotensive parturients. When hypotension does occur in preeclamptic women, its overall magnitude is manageable and successfully corrected with standard vasopressor therapy, confirming that spinal anesthesia is a safe and reliable option for this high-risk population.