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Spinal Anesthesia in Severe Preeclampsia

Henke, Vanessa G. MD*†; Bateman, Brian T. MD; Leffert, Lisa R. MD

doi: 10.1213/ANE.0b013e31829eeef5
Obstetric Anesthesiology: Focused Review

Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe preeclampsia, provided there is no indwelling epidural catheter or contraindication to neuraxial anesthesia. Compared with healthy parturients, those with severe preeclampsia experience less frequent, less severe spinal-induced hypotension. In severe preeclampsia, spinal anesthesia may cause a higher incidence of hypotension than epidural anesthesia; however, this hypotension is typically easily treated and short lived and has not been linked to clinically significant differences in outcomes. In this review, we describe the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia and the evidence guiding intraoperative hemodynamic management.

Published ahead of print July 18, 2013

From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, California; and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Accepted for publication May 7, 2013.

Published ahead of print July 18, 2013

Funding: Departmental.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Vanessa G. Henke, MD, UCLA Department of Anesthesiology, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403. Address e-mail to

© 2013 International Anesthesia Research Society