Anaesthesia and fluid management for women with a hypertensive disorder of pregnancy
This section is not designed to be an anaesthetic text but focuses on anaesthetic issues specifically related to parturients with a HDP. As a general rule, early consultation and involvement of anaesthesia will result in the best possible outcome for women with a HDP and their babies (14, 15).
Therefore, the duty anaesthetist should be informed when a woman with pre-eclampsia is admitted to the delivery suite. The anaesthetist should assess the woman with pre-eclampsia from the standpoint of possible anaesthetic care and as her status may change, she should be reassessed.Provision of effective analgesia for labour will not only decrease pain, but will attenuate its effects on BP and cardiac output. In addition, epidural analgesia benefits the fetus by decreasing maternal respiratory alkalosis, compensatory metabolic acidosis, and release of catecholamines. Therefore, early insertion of an epidural catheter (in the absence of contraindications) is recommended. An effective labour epidural can be used should a caesarean delivery be required, avoiding the need for general anaesthesia. To reduce risks associated with neuraxial anaesthesia (epidural, spinal, continuous spinal, and combined spinal epidural), women with pre-eclampsia should have a platelet count on admission to the delivery suite.
In the absence of contraindications, all of the following are acceptable methods of anaesthesia for women undergoing caesarean section: epidural, spinal, continuous spinal, combined spinal epidural, and general anaesthesia (14, 15). The choice of technique will depend on the overall condition of the parturient, the urgency of the situation, and whether there are contraindications to any particular technique. Challenges associated with anaesthesia include maintaining haemodynamic stability during laryngoscopy and intubation with general anaesthesia, or after sympathetic block secondary to neuraxial anaesthesia.
Although neuraxial anaesthesia is preferred to general anaesthesia, due to potential problems with the airway in the woman with pre-eclampsia, neuraxial anaesthesia may not be possible in the presence of a low platelet count or other coagulation abnormality (14, 15). A routine, fixed intravenous fluid bolus should not be administered prior to neuraxial anaesthesia (14, 15). The interaction of non-depolarizing muscle relaxants (as part of general anaesthesia)