Spinal anesthesia after rapid treatment of pulmonary edema in patient with severe preeclampsia: a case report.

INTRODUCTION AND

IMPORTANCE

Severe preeclampsia is a significant cause of maternal and neonatal morbidity and mortality. The choice of anesthesia technique in such cases is particularly challenging, as both general anesthesia (GA) and regional anesthesia (RA) have their own advantages and limitations.

CASE PRESENTATION: A 28-year-old primigravida Iranian woman with a twin pregnancy at 30 weeks and 3 days of gestation, with a history of diet-controlled gestational diabetes, a body mass index of 35 kg/m2, and a history of upper respiratory tract infection approximately 4 weeks' prior, presented to the emergency department at 5:30 PM with complaints of hypertension and epigastric discomfort. Her blood pressure was recorded at 160/110 mmHg. The anesthesiologist confirmed that the pulmonary edema was of non-cardiac origin. After treatment of the pulmonary edema and stabilization of the patient's hemodynamic status, spinal anesthesia (SA) was performed using 0.5% hyperbaric bupivacaine (Marcaine), leading to the successful delivery of two male infants.

CLINICAL DISCUSSION: The decision to perform SA, despite the initial presence of acute respiratory distress, was made after rapid and effective hemodynamic and pulmonary stabilization. This approach reflects a deliberate risk-benefit analysis in favor of RA, given its advantages - such as reduced airway-related complications, decreased fetal drug exposure, and a lower risk of cardiovascular events during laryngoscopy - when compared to GA.

CONCLUSION

In individuals presenting with severe preeclampsia and non-cardiac pulmonary edema, SA may be judiciously administered by a proficient anesthesiologist once hemodynamic parameters and oxygenation are adequately managed with emergency pharmacological interventions.