Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
In Reply: We agree with Dr Mandal that the
anesthesiologist is an important member of the care team for women with preeclampsia.
Several studies have evaluated maternal and fetal safety of regional anesthesia
by comparing the maternal hemodynamic response, maternal outcomes, and neonatal
outcomes among patients who received epidural, spinal, general, or patient-administered
analgesia. Wallace et al1 compared general,
epidural, and combined spinal-epidural and found differences in the use of
ephedrine for hypotension and volume of intravenous fluids administered but
no differences in Apgar scores, umbilical artery pH, or respiratory distress.
They also found an increase in special care nursery admissions with epidural
anesthesia.1 The study by Hood and Curry2 also supports the use of regional anesthesia. They
demonstrated similar maternal and neonatal outcomes with epidural compared
with spinal anesthesia with the exception of the spinal group receiving more
intravenous fluids and antihypertensives. Overall change in blood pressure
was similar. A retrospective study by Moodley et al3 noted
comparable outcomes with general and epidural anesthesia and noted a higher
1-minute Apgar score in infants whose mothers received epidural anesthesia.
In patients in labor, epidural anesthesia was superior to patient-administered
analgesia but did not produce additional therapeutic benefit.4
Lain KY, Roberts JM. Anesthesia and Preeclampsia—Reply. JAMA. 2002;288(15):1847-1848. doi:10.1001/jama.288.15.1845