Anesthetic Modification of Hernodynamic and Neuroendocrine Stress Responses to Cesarean Delivery in Women With Severe Preeclampsia

Abstract

We conducted a prospective evaluation of the comparative effects of lumbar epidural and general anesthesia on the hemodynamic and neuroendocrine stress response to cesarean delivery in 21 women with severe preeclampsia. In the epidural group (n = 11), anesthesia extending to the T-4 dermatome level was obtained using 2% plain lidocaine in divided doses. In the general anesthesia group (n = 10), anesthesia was induced after pretreatment with labetalol or nitroglycerine. In the epidural group, mean arterial pressure (MAP) gradually decreased from 133.3 ± 5.6 mm Hg to 119 ± 4.4 mm Hg (P < 0.002). After pretreatment with labetalol or nitroglycerine, MAP in the general group decreased from 131.5 ± 4.9 mm Fig to 112.2 ± 3.5 mm Hg (P < 0.001). At skin incision (after tracheal intubation), MAP increased from 112.2 ± 3.5 mm Hg to 143 ± 5.4 mm Hg (P < 0.001); however, this was not significantly different from baseline MAP. In the epidural group, there were no further changes in MAP. The difference in MAP at skin incision and postpartum period between the two groups was significant (P < 0.004 and P < 0.009, respectively). In the general anesthesia group, both adrenocorticotropic hormone and β-endorphin-like immunoactivity increased significantly from base levels at skin incision. The catecholamines also increased significantly and remained so throughout the study period. In the epidural group, the concentrations of these hormones decreased or remained unchanged. Cortisol concentrations in the postpartum period were significantly higher in both groups. There were more neonates with Apgar scores of less than 7 at 1 min in the general anesthesia group. Stress hormone concentrations in the neonates in both groups were similar, and no correlations were found between maternal and neonatal hormone concentrations in the two groups. We conclude that epidural anesthesia extending to the T-4 dermatome caused blunting of the hemodynamic and neuroendocrine stress responses to cesarean delivery in women with severe preeclampsia. The anesthetic technique did not alter the neonatal stress hormone concentrations at birth.