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To the Editor: In their Contempo Updates article on preeclampsia, Drs Lain and Roberts¹ did not mention the role of regional analgesia and anesthesia (eg, spinal, epidural, and combined spinal-epidural) in high-risk patients. Although controversial, many investigators have recommended the use of epidural anesthesia in severe preeclampsia and eclampsia to help control blood pressure and pain and increase uterine and renal perfusion.² One study has also found a higher Apgar score in infants whose mothers received epidural anaesthesia.³ It is a common practice to use these regional techniques (when they are not contraindicated) in such patients for peripartum care.⁴

Nanda G. Mandal, MBBS,MD,DA,FRCA
Department of Anaesthesia
Peterborough District Hospital
Peterborough, England

1. Lain KY, Roberts JM. Contemporary concepts of the pathogenesis and management of preeclampsia. JAMA. 2002;287:3183-3186. FREE FULL TEXT 2. Shnider SM, Levinson G. Anesthesia for obstetrics. In: Miller RD, ed. Anesthesia. 4th ed. New York, NY: Churchill Livingstone; 1994:2031-2076. 3. Moodley J, Jjuuko G, Rout C. Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia. Br J Obstet Gynaecol. 2001;108:378-382. FULL TEXT 4. Hood DD, Curry R. Spinal versus epidural anesthesia for caesarean section in severely preeclamptic patients: a retrospective survey. Anesthesiology. 1999;90:1276-1282. ISI | PUBMED

In Reply: We agree with Dr Mandal that the anesthesiologist is an important member of the care team for women with preeclampsia. Several studies have evaluated maternal and fetal safety of regional anesthesia by comparing the maternal hemodynamic response, . . . [Full Text of this Article]

RELATED ARTICLE

Contemporary Concepts of the Pathogenesis and Management of Preeclampsia
Kristine Y. Lain and James M. Roberts
JAMA. 2002;287(24):3183-3186.
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