Epidemiology: t he incidence of major complications after neuraxial techniques in pregnant women in general is approximately 1/25'000 for spinal anesthesia and epidural analgesia.
Indication: - In the absence of contraindications, lumbar neuraxial analgesia is appropriate for women with pre-eclampsia during labor and neuraxial anaesthesia is the preferred method for anaesthesia for caesarean birth in women with pre-eclampsia. In the absence of other coagulation abnormalities, the risk of haematoma associated with neuraxial anaethesia with platelet counts (<2 h) >100 G/l is very low.
- Auch bei beginnendem HELLP-Syndrom und grenzwertigen Thrombozyten (70-80'000 G/l) kann noch eine Spinalanästhesie gemacht werden (2).
Contraindication: no epidural analgesia if platelet count <100 G/l (1,2).
Measurements: vor EDA-Katheterentfernung Thrombozyten bestimmen; EDA-Katheter nicht wie üblich durch Hebammen entfernen lassen (2).
Treatment: - Nur kleiner "Flüssigkeitspreload" (200-300 ml), bei schwerer Präeklampsie grosszügig arterielle Blutdruckmessung installieren (2)
- Hypotension requiring vasopressor medication during neuraxial anaesthesia is less common in women with pre-eclampsia than in healthy women. If hypotension occurs, it may be successfully managed with titrated doses of intravenous ephedrine (3-5 mg bolus) or phenylephrine (50-100 mg bolus) (1). Starke Blutdruckabfälle nach Kindsentwicklung typisch (2).
- The use of adrenaline-containing local anaesthetic solutions for epidural boluses to provide surgical anaesthesia appears to be safe, and is widely used to minimise systemic absorption of local anaesthetics. There has been a single case report of a hypertensive crisis with absorbed adrenaline, emphasising the need for close observation of these women (1).
References: - Management of pre-eclampsia. Anaesthesia 2012,67,1009-1020: full text | pdf
- Blaubuch Frauenklinik KSA: link (Nr. 59/2).
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