Anesthetic Management in Preeclampsia

Main Article Content

Sasima Dusitkasem
Peeradol Chantarasaereerak


Parturients with preeclampsia are at significant risk of perioperative morbidity and mortality. Understanding the pathophysiology and hemodynamic changes of the disease are essential to optimize maternal and fetal outcomes. Anesthesiologist together with multidisciplinary team plays a crucial role in establishment of optimal management during anesthesia in patients with preeclampsia.

Article Details

Review articles


Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol. 2017;130:366-73.

Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol. 2015;125:5-12.

กระทรวงสาธารณสุข. ตัวชี้วัดที่ 1.6 อัตราส่วนการตายมารดาไทยต่อการเกิดมีชีพแสนคน [ออนไลน์]. [เข้าถึงวันที่ 1 ตุลาคม 2565]; [2 หน้า]. แหล่งที่มา:

Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135:e237-60.

Hod T, Cerdeira AS, Karumanchi SA. Molecular mechanisms of preeclampsia. Cold Spring Harb Perspect Med. 2015;5:a023473.

Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation. 2011;123:2856-69.

Thilaganathan B, Kalafat E. Cardiovascular system in preeclampsia and beyond. Hypertension. 2019;73:522-31.

Martin JN Jr, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105:246-54.

Dennis AT. Transthoracic echocardiography in women with preeclampsia. Curr Opin Anaesthesiol. 2015;28:254-60.

Castleman JS, Ganapathy R, Taki F, Lip GY, Steeds RP, Kotecha D. Echocardiographic structure and function in hypertensive disorders of pregnancy: a systematic review. Circ Cardiovasc Imaging. 2016;9:e004888.

Gammill HS, Chettier R, Brewer A, et al. Cardiomyopathy and preeclampsia: shared genetics? Circulation. 2018;138:2359-66.

Duley L, Williams J, Henderson-Smart DJ. Plasma volume expansion for treatment of women with pre-eclampsia. Cochrane Database Syst Rev. 2000;1999:CD001chec805.

Pretorius T, van Rensburg G, Dyer RA, Biccard BM. The influence of fluid management on outcomes in preeclampsia: a systematic review and meta-analysis. Int J Obstet Anesth. 2018;34:85-95.

National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management: NICE guideline [NG133]. NICE, 2019. [Accessed 1 October 2022].

Lowe SA, Bowyer L, Lust K, et al. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol. 2015;55:e1-29.

Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;2010:CD000025.

Assali NS, Prystowsky H. Studies on autonomic blockade. I. Comparison between the effects of tetraethylammonium chloride (TEAC) and high selective spinal anesthesia on blood pressure of normal and toxemic pregnancy. J Clin Invest. 1950;29:1354-66.

Aya AGM, Mangin R, Vialles N, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg. 2003;97:867-72.

Aya AGM, Vialles N, Tanoubi I, et al. Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery. Anesth Analg. 2005;101:869-75.

Dyer RA, Piercy JL, Reed AR, Lombard CJ, Schoeman LK, James MF. Hemodynamic changes associated with spinal anesthesia for cesarean delivery in severe preeclampsia. Anesthesiology. 2008;108:802-11.

Dyer RA, Daniels A, Vorster A, et al. Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre-eclampsia: a randomised, controlled trial. Anaesthesia. 2018;73:23-31.

Thornton CE, von Dadelszen P, Makris A, Tooher JM, Ogle RF, Hennessy A. Acute pulmonary oedema as a complication of hypertension during pregnancy. Hypertens Pregnancy. 2011;30:169-79.

Dyer RA, Emmanuel A, Adams SC, et al. A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise. Int J Obstet Anesth. 2018;33:23-31.

Heesen M, Rijs K, Hilber N, et al. Ephedrine versus phenylephrine as a vasopressor for spinal anaesthesia-induced hypotension in parturients undergoing high-risk caesarean section: meta-analysis, meta-regression and trial sequential analysis. Int J Obstet Anesth. 2019;37:16-28.

Moodley J, Jjuuko G, Rout C. Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia. BJOG. 2001;108:378-82.

Visalyaputra S, Rodanant O, Somboonviboon W, Tantivitayatan K, Thienthong S, Saengchote W. Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. Anesth Analg. 2005;101:862-8.

Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anaesthesia for caesarean section in preeclamptic patients. Int J Obstet Anesth. 2003;12:23-7.

Lee LO, Bateman BT, Kheterpal S, et al. Multicenter perioperative outcomes group investigators. Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients: a report from the multicenter perioperative outcomes group. Anesthesiology. 2017;126:1053-63.

Bauer ME, Arendt K, Beilin Y, et al. The Society for Obstetric Anesthesia and Perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia. Anesth Analg. 2021;132:1531-44.

Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB. Coagulation profile in severe preeclampsia. Obstet Gynecol. 1992;79:14-8.

Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol. 1986;155:501-9.

De Gracia PV, Silva S, Montufar C, Carrol I, De Los Rios S. Anesthesia in pregnant women with HELLP syndrome. Int J Gynaecol Obstet. 2001;74:23-7.

del-Rio-Vellosillo M, Garcia-Medina JJ. Anesthetic considerations in HELLP syndrome. Acta Anaesthesiol Scand. 2016;60:144-57.

Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118(Suppl1):1-203.

Smit MI, du Toit L, Dyer RA, et al. Hypoxaemia during tracheal intubation in patients with hypertensive disorders of pregnancy: analysis of data from an obstetric airway management registry. Int J Obstet Anesth. 2021;45:41-8.

Li YH, Novikova N. Pulmonary artery flow catheters for directing management in pre-eclampsia. Cochrane Database Syst Rev. 2012;CD008882.

Bansal S, Pawar M. Haemodynamic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension: effect of intravenous esmolol with or without lidocaine. Int J Obstet Anesth. 2002;11:4-8.

Ducey JP, Knape KG. Maternal esmolol administration resulting in fetal distress and cesarean section in a term pregnancy. Anesthesiology. 1992;77:829-32.

Ramanathan J, Sibai BM, Mabie WC, Chauhan D, Ruiz AG. The use of labetalol for attenuation of the hypertensive response to endotracheal intubation in preeclampsia. Am J Obstet Gynecol. 1988;159:650-4.

Heida KY, Zeeman GG, van Veen TR, Hulzebos CV. Neonatal side effects of maternal labetalol treatment in severe preeclampsia. Early Hum Dev. 2012;88:503-7.

Bateman BT, Patorno E, Desai RJ, et al. Late pregnancy β blocker exposure and risks of neonatal hypoglycemia and bradycardia. Pediatrics. 2016;138:e20160731.

Hood DD, Dewan DM, James FM 3rd, Floyd HM, Bogard TD. The use of nitroglycerin in preventing the hypertensive response to tracheal intubation in severe preeclampsia. Anesthesiology. 1985;63:329-32.

Safavi M, Honarmand A, Azari N. Attenuation of the pressor response to tracheal intubation in severe preeclampsia: relative efficacies of nitroglycerine infusion, sublingual nifedipine, and intravenous hydralazine. Anesth Pain Med. 2011;1:81-9.

Hanff LM, Vulto AG, Bartels PA, et al. Intravenous use of the calcium-channel blocker nicardipine as second-line treatment in severe, early-onset pre-eclamptic patients. J Hypertens. 2005;23:2319-26.

Pant M, Fong R, Scavone B. Prevention of peri-induction hypertension in preeclamptic patients: a focused review. Anesth Analg. 2014;119:1350-6.

Miller EMS, Sakowicz A, Leger E, Lange E, Yee LM. Association between receipt of intrapartum magnesium sulfate and postpartum hemorrhage. AJP Rep. 2021;11:e21-5.

Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;2010:CD000025.

Tyagi A, Mohan A, Singh Y, Luthra A, Garg D, Malhotra RK. Effective dose of prophylactic oxytocin infusion during cesarean delivery in 90% population of nonlaboring patients with preeclampsia receiving magnesium sulfate therapy and normotensives: an up-down sequential allocation dose-response study. Anesth Analg. 2022;134:303-11.

Langesæter E, Rosseland LA, Stubhaug A. Haemodynamic effects of oxytocin in women with severe preeclampsia. Int J Obstet Anesth. 2011;20:26-9.

Nucci B, Aya A, Aubry E, Ripart J. Carbetocin for prevention of postcesarean hemorrhage in women with severe preeclampsia: a before-after cohort comparison with oxytocin. J Clin Anesth. 2016;35:321-5.

Lewis G. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer-2003-2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom, London, UK: CEMACH, 2007.