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Federación Mexicana de Ginecología y Obstetricia, A.C.

2024, Number 08

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Ginecol Obstet Mex 2024; 92 (08)

Anesthetic complications in patients with preeclampsia with severity criteria

Marisancén CK, Villegas AJD, Martínez SLM, Durango SC, Saavedra VME, Vera MC, Jaramillo JLI

Language: Spanish
References: 39
Page: 315-325
PDF size: 208.77 Kb.


ABSTRACT

Objective: To describe anesthetic complications in patients with pre-eclampsia with severity criteria.
Materials and Methods: Observational, retrospective, cross-sectional, descriptive study conducted in a tertiary care center in the city of Medellin, Colombia, between January 2016 and January 2021. The source of information was medical records. Inclusion criteria: pregnant patients, with pre-eclampsia with severity criteria, who received neuroaxial or general anesthesia. Exclusion criteria: patients with previous diagnosis of coagulopathies and with other hypertensive disorders of pregnancy unrelated to preeclampsia with severe characteristics. Non-probability sampling of consecutive cases and univariate analysis were performed.
Results: Fifty-eight patients were included; 69% terminated the pregnancy by cesarean section. Eighty-nine.4% received neuroaxial anesthesia and 10.6% general anesthesia. 29.9% were admitted to intensive care, 4.7% had hypotension, 3.9% required vasopressor support, 3.7% had difficult airway, 0.98% required mechanical ventilation. One patient had pulmonary edema and one patient had hemorrhagic stroke. Urinary retention occurred in 1.5% of patients receiving spinal anesthesia. The incidence of failed neuroaxial anesthesia was 1.4% for labor and 1.3% for cesarean section. There were no cases of death, meningitis, arachnoiditis, paraplegia, accidental dura puncture, or allergic reaction.
Conclusions: Neuroaxial anesthesia remains the anesthetic technique of choice in patients with pre-eclampsia with severity criteria. The most common anesthetic complications were ICU admission, hypotension, and need for vasopressor support.


REFERENCES

  1. Rosas-Peralta M, Borrayo-Sánchez G, Madrid-Miller, etal. Hipertensión durante el embarazo: el reto continúa.Rev Med Inst Mex Seguro Soc 2016; 54 Suppl 1: s90-s111.https://www.medigraphic.com/pdfs/imss/im-2016/ims161g.pdf

  2. Hypertension in pregnancy. Report of the AmericanCollege of Obstetricians and Gynecologists TaskForce on Hypertension in Pregnancy. Obstet Gynecol2013; 122 (5): 1122-1131. https://doi.org/10.1097/01.AOG.0000437382.03963.88

  3. Tsakiridis I, Giouleka S, Arvanitaki A, et al. Gestationalhypertension and preeclampsia: an overview of nationaland international guidelines. Obstet Gynecol Surv2021; 76 (10): 613-33. https://pubmed.ncbi.nlm.nih.gov/34724074/

  4. Gestational Hypertension and Preeclampsia: ACOGPractice Bulletin Summary, Number 222. Obstet Gynecol2020; 135 (6): 1492-1495. https://doi.org/10.1097/AOG.0000000000003892.

  5. Poon LC, Shennan A, Hyett JA, et al. The InternationalFederation of Gynecology and Obstetrics (FIGO) initiativeon pre-eclampsia: A pragmatic guide for first-trimesterscreening and prevention. Int J Gynaecol Obstet 2019;145 (Suppl 1): 1-33. https://doi.org/10.1002/ijgo.12802

  6. Rana S, Lemoine E, Granger JP, et al. Preeclampsia:pathophysiology, challenges, and perspectives. Circ Res2019; 124 (7): 1094-1112. https://doi.org/10.1161/CIRCRESAHA.118.313276

  7. Romero XC, Montserrat U, Porras-Ramírez A, et al.Epidemiological characteristics of hypertensive disordersduring pregnancy in a high-risk population. Rev BrasSaude Mater Infant 2022; 22 (3): 497-505. https://doi.org/10.1590/1806-9304202200030004

  8. Salamanca-Sánchez AL, Nieves-Díaz LA, Arenas- CárdenasYM. Preeclampsia: prevalencia y factores asociados en gestantesde una institución de salud de Boyacá en el periodo2015 a 2017. Revista Investig Salud Univ Boyacá 2019; 6 (2):40-52. https://doi.org/10.24267/23897325.422

  9. Tranquilli AL, Dekker G, Magee L, et al. The classification, diagnosisand management of the hypertensive disorders ofpregnancy: A revised statement from the ISSHP. PregnancyHypertens 2014; 4 (2): 97-104. https://doi.org/10.1016/j.preghy.2014.02.001

  10. Wilkerson RG, Ogunbodede AC. Hypertensive disorders ofpregnancy. Emerg Med Clin North Am 2019; 37 (2): 301-16.https://doi.org/10.1016/j.emc.2019.01.008

  11. Magee LA, Pels A, Helewa M, Rey E, et al. Canadian HypertensiveDisorders of Pregnancy Working Group. Diagnosis,evaluation, and management of the hypertensive disordersof pregnancy: executive summary. J Obstet Gynaecol Can2014; 36 (5): 416-38. https://doi.org/10.1016/s1701-2163(15)30588-0

  12. Hawkins JL. Epidural analgesia for labor and delivery. N EnglJ Med 2010; 362 (16): 1503-10. https://doi.org/10.1056/NEJMct0909254

  13. van Dyk D, Dyer RA, Fernandes NL. Preeclampsia in 2021-a Perioperative Medical Challenge for the Anesthesiologist.Anesthesiol Clin 2021; 39 (4): 711-25. https://doi.org/10.1016/j.anclin.2021.08.005

  14. Aya AGM, Mangin R, Vialles N, et al. Patients with severepreeclampsia experience less hypotension during spinalanesthesia for elective cesarean delivery than healthyparturients: a prospective cohort comparison. AnesthAnalg 2003; 97 (3): 867-72. https://doi.org/10.1213/01.ANE.0000073610.23885.F2

  15. Alemayehu TY, Berhe YW, Getnet H, et al. Hemodynamicchanges after spinal anesthesia in preeclamptic patientsundergoing cesarean section at a tertiary referral centerin Ethiopia: a prospective cohort study. Patient Saf Surg2020; 14: 9. https://doi.org/10.1186/s13037-020-00234-w.

  16. Chooi C, Cox JJ, Lumb RS, et al. Techniques for preventinghypotension during spinal anaesthesia for caesareansection. Cochrane Database Syst Rev 2017; 8:Cd002251. https://doi.org/10.1002/14651858.CD002251

  17. Chattopadhyay S, Das A, Pahari S. Fetomaternal outcomein severe preeclamptic women undergoing emergencycesarean section under either general or spinal anesthesia.J Pregnancy 2014; 2014: 325098. https://doi.org/10.1155/2014/325098

  18. Hariharan N, Shoemaker A, Wagner S. Pathophysiology ofhypertension in preeclampsia. Microvasc Res 2017; 109:34-37. https://doi.org/10.1016/j.mvr.2016.10.002

  19. Santos AC, Birnbach DJ. Spinal anesthesia for cesareandelivery in severely preeclamptic women: Don'tthrow out the baby with the bathwater! Anesth Analg

  20. 2005; 101 (3): 859-861. https://doi.org/10.1213/01.ANE.0000175218.75396.8220. Cheng C, Liao AH, Chen CY, et al. A systematic review withnetwork meta-analysis on mono strategy of anaesthesiafor preeclampsia in caesarean section. Sci Rep 2021; 11(1): 5630. https://doi.org/10.1038/s41598-021-85179-5

  21. Visalyaputra S, Rodanant O, Somboonviboon W, et al.Spinal versus epidural anesthesia for cesarean deliveryin severe preeclampsia: a prospective randomized, multicenterstudy. Anesth Analg 2005; 101 (3): 862-68. https://doi.org/10.1213/01.ANE.0000160535.95678.34

  22. Gupta S, Partani S. Neuraxial techniques of labour analgesia.Indian J Anaesth 2018; 62 (9): 658-66. https://doi.org/10.4103/ija.IJA_445_18

  23. Sobhy S, Dharmarajah K, Arroyo-Manzano D, et al. Typeof obstetric anesthesia administered and complicationsin women with preeclampsia in low- and middle-incomecountries: Type of obstetric anesthesia administered andcomplications in women with preeclampsia in low- andmiddle-income countries: A systematic review. HypertensPregnancy. 2017;36(4):326-36. https://www.tandfonline.com/doi/full/10.1080/10641955.2017.1389951

  24. Katore FH, Gurara AM, Beyen TK. Determinants of preeclampsiaamong pregnant Women in Chiro ReferralHospital, Oromia Regional State, Ethiopia: UnmatchedCase-Control Study. Integr Blood Press Control 2021; 14:163-172. https://doi.org/10.2147/IBPC.S336651

  25. Murad-Rivera R, Rivillas-García JC, Vargas-Pinzón V, etal. Determinantes del embarazo en adolescentes enColombia: explicando las causas de las causas. AsociaciónProfamilia. https://profamilia.org.co/wp-content/uploads/2020/07/2018-Murad-Determinantes-delembarazo-preprint.pdf

  26. Nankali A, Malek-Khosravi Sh, Zangeneh M, et al. Maternalcomplications associated with severe preeclampsia. JObstet Gynaecol India 2013; 63 (2): 112-115. https://doi.org/10.1007/s13224-012-0283-0

  27. Chumpathong S, Sirithanetbhol S, Salakij B, et al. Maternaland neonatal outcomes in women with severe pre-eclampsiaundergoing cesarean section: a 10-year retrospectivestudy from a single tertiary care center: anesthetic pointof view. J Matern Fetal Neonatal Med 2016; 29 (24): 4096-100. https://doi.org/10.3109/14767058.2016.1159674

  28. Wang G, Zhang P, Li M, et al. [Retracted] Effect of combinedspinal-epidural anesthesia and total intravenousanesthesia on hemodynamics and pregnancy outcomesof severe preeclampsia pregnant patients undergoingcesarean section. Khan N, editor. Evid Based ComplementAlternat Med 2022; 2022: 2655858. https://doi.org/10.1155/2022/2655858

  29. Ram M, Anteby M, Weiniger CF, et al. Acute pulmonaryedema due to severe preeclampsia in advanced maternalage women. Pregnancy Hypertens 2021; 25: 150-155.https://doi.org/10.1016/j.preghy.2021.05.019

  30. Murphy DJ, Stirrat GM. Mortality and morbidity associatedwith early-onset preeclampsia. Hypertens Pregnancy 2000;19 (2): 221-31. https://doi.org/10.1081/prg-100100138

  31. Magee LA, von Dadelszen P. State-of-the-art diagnosisand treatment of hypertension in pregnancy. Mayo ClinProc 2018; 93 (11): 1664-77. https://doi.org/10.1016/j.mayocp.2018.04.033

  32. Aregawi A, Terefe T, Admasu W, et al. Comparing the effectof spinal and general anaesthesia for pre-eclamptic motherswho underwent caesarean delivery in a tertiary, AddisAbaba, Ethiopia. Ethiop J Health Sci 2018; 28 (4): 443-50.https://doi.org/10.4314/ejhs.v28i4.10

  33. Brown MA, Magee LA, Kenny LC, et al. Hypertensive disordersof pregnancy: ISSHP classification, diagnosis, andmanagement recommendations for international practice.Hypertension 2018; 72: 24-43. https://doi.org/10.1161/HYPERTENSIONAHA.117.10803

  34. Aparna B, Suvarna V, Balasaraswathi M, et al. Evaluationof severity of pregnancy induced hypertension usingthrombocytopenia as a prognostic indicator and its correlationwith maternal and fetal outcome. Int J Acad MedPharm 2022; 4 (4); 203-210. https://doi.org/10.47009/jamp.2022.4.4.40

  35. Gupta A, Dhama V, Singh S, et al. Evaluating associationbetween thrombocytopenia and hypertension in pregnancyand its fetomaternal outcome. Int J Reprod ContraceptObstet Gynecol 2023; 12 (5): 1429-34. https://doi.org/10.18203/2320-1770.ijrcog20231236

  36. Seymour LM, Fernandes NL, Dyer RA, et al. General anesthesiafor cesarean delivery for thrombocytopenia inhypertensive disorders of pregnancy: findings from the obstetricairway management registry. Obstetric AnesthesiaDigest 2023: 43 (4): 212-214. https://doi.org/10.1097/01.aoa.0000990500.49734.ca

  37. Beilin Y, Zahn J, Comerford M. Safe epidural analgesia inthirty parturients with platelet counts between 69,000 and98,000 mm (-3). Anesth Analg 1997; 85 (2): 385-8. https://doi.org/10.1097/00000539-199708000-00025

  38. Pan PH, Bogard TD, Owen MD. Incidence and characteristicsof failures in obstetric neuraxial analgesia and anesthesia:a retrospective analysis of 19,259 deliveries. Int J ObstetAnesth 2004; 13 (4): 227-33. https://doi.org/10.1016/j.ijoa.2004.04.008

  39. Klöhr S, Roth R, Hofmann T, et al. Definitions of hypotensionafter spinal anesthesia for caesarean section:literature search and application to parturients. ActaAnaesthesiol Scand 2010; 54 (8): 909-21. https://doi.org/10.1111/j.1399-6576.2010.02239.x




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