Anesthesia and Preeclampsia—Reply

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, maternal outcomes, and neonatal outcomes among patients who received epidural, spinal, general, or patient-administered analgesia. Wallace et al¹ compared general, epidural, and combined spinal-epidural and found differences in the use of ephedrine for hypotension and volume of intravenous fluids administered but no differences in Apgar scores, umbilical artery pH, or respiratory distress. They also found an increase in special care nursery admissions with epidural anesthesia.¹ The study by Hood and Curry² also supports the use of regional anesthesia. They demonstrated similar maternal and neonatal outcomes with epidural compared with spinal anesthesia with the exception of the spinal group receiving more intravenous fluids and antihypertensives. Overall change in blood pressure was similar. A retrospective study by Moodley et al³ noted comparable outcomes with general and epidural anesthesia and noted a higher 1-minute Apgar score in infants whose mothers received epidural anesthesia. In patients in labor, epidural anesthesia was superior to patient-administered analgesia but did not produce additional therapeutic benefit.⁴