Background and Goal of Study:
The clinical spectrum of a patient with eclampsia varies considerably. It’s difficult to apply general recommendations for anaesthesia care for these patients. General anaesthesia is often mandatory and the use of regional anaesthesia was reported in case of stable eclampsia.
We studied anaesthesia techniques and related morbidity and mortality amongst eclamptic patients in a third level hospital.
Materials and Methods:
We conducted a retrospective survey of hospital anaesthesia records of patients with eclampsia who underwent caesarean delivery at a third level hospital over a 13-year span from January 2004 to December 2016.
Results:
Eighty three eclamptic patients were recorded during our study period. The incidence of eclampsia was 
64 per 100000 deliveries. In 61 patients (73.5%) general anaesthesia was performed. In those patients, the major events were difficult intubation in 3 patients, aspiration in 2 patients and intra-operative haemorrhage in 2 patients. The hemodynamic effects associated with laryngoscopy and endotracheal intubation revealed a change in the heart rate from 104 ± 10 to 133 ± 17 beats/min and an increase in mean arterial pressure from 94 ± 1.1 to 112 ± 3.2 mm Hg. Median APGAR score at 1and5 min were 7 and 8 respectively.In 22 patients (26.5%) spinal anaesthesia was performed after stabilization. Computed tomography was performed in 7 patients and was normal in all cases. Only two patients had episodes of hypotension. No patient had a perioperative convulsion. Median APGAR score at 1 and 5 minutes were 8 and 9 respectively.There were no maternal deaths. we reported 5 stillbirths and 2 neonatal deaths, all with general anaesthesia.
Conclusion(s):
The risk-benefit profiles of spinal anesthesia and general anesthesia strongly favor the use of spinal anesthesia when feasible. Important factors to consider are the risks of clinically significant maternal hemodynamic derangements, difficult airway management, stroke, spinal/epidural hematoma, and adverse neonatal outcomes. In eclamptic patients, spinal anesthesia–induced hypotension is typically easily treated.  The risk of spinal/epidural hematoma is low, and there is no evidence that neonatal outcomes are compromised. In contrast, potential complications of general anesthesia, such as hypertensive crisis, stroke, and difficult airway management, are leading causes of morbidity and mortality in this population.

02 / Maternal and neonatal outcomes associated with the use of spinal anesthesia compared with general anesthesia in severe preeclampsia: a retrospective study.
