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Editor-in-Chief :
Mohamad Said Maani Takrouri
(KSA)
Open Access
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Review Article
Abstract
Eclampsia is one of the most common emergencies encountered by anesthesiologists which
involve a safe journey of two lives. The definition, etiology, pathophysiology, treatment guidelines
along with a special reference to management of labour pain and caesarean section are discussed.
Eclampsia is commonly faced challenging case in our day to day anaesthesia practice,but less is
discussed in our anaesthesia text books. Lot of controversies with regard to fluid management
and monitoring still remain unanswered
Key words: Anesthesia, caesarean, eclampsia
DOI
www.aeronline.org
10.4103/0259-1162.123214
Etiology
Pathogenesis of seizures
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Endothelial Damage
Platelet
aggregation,
Thrombocytopenia,
Haemolytic
anemia, elevated
liver enzymes
HELLP
Decreased
production of
vasodilators
Increased
vascular
sensitivity to
angiotensin and
nor epinephrine
leading to
vasospasm
Decreased
sensitivity to
vasodilators.
Increased SVR
Increased glomerular
capillary permeability
leading to proteinuria
Decreased GFR
and RBF
Decreased aldosterone
escape, increased sodium
and water retention
Edema
Hypertension
Figure 1: Hypothesis of mechanism of endothelial damage leading to preeclampsia-eclampsia
Clinical features
Role of imaging
Role of anesthesiologist
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Control of hypertension
Preanesthetic evaluation
Problems
Seizure control
Blood pressure control: Appropriate treatment must be
instituted if the diastolic pressure exceeds 110 mmHg
The possibility of increased ICP need not concern the
anesthesiologist if the patient remains conscious, alert,
and seizure free
Persistent coma and localizing signs may indicate major
intracranial pathology, which would affect anesthetic
management
Maintenance of fluid balance: intake should be restricted
to 80 ml/h
Monitoring of maternal oxygenation by continuous
pulse oximetry
Keep blood products available
Coagulation studies should be undertaken regardless of
the platelet count
Judicious preloading if hypovolemia is suspected or
post vasodilator therapy.
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General anesthesia
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Sustained high BP
Potential rapid BP fluctuations
Inability to obtain BP by cuff
Repeated sampling
Use of peripheral vasodilators
Concepts about pulmonary edema.
Thromboprophylaxis
Postpartum management
CONCLUSION
The definitive treatment is delivery. However, it is
inappropriate to deliver an unstable mother even if
there is fetal distress. Once seizures are controlled,
severe hypertension treated and hypoxia corrected,
delivery can be expedited. Always consider prophylaxis
against thromboembolism. The fluid management along
with magnesium and antihypertensive therapy with
strict hemodynamic vigilance is to be continued in the
postpartum period.
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