الفهرس 
Introduction and Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Aim of the work
To compare the anesthetic modification of maternal hemodynamic responses to cesarean delivery and neonatal outcome in women with pregnancy induced hypertension receiving epidural versus general anesthesia using labetalol as a pretreatment.
Conclusions
The results of this study showed that in group I, the general anesthesia group, labetalol caused a smooth and gradual reduction of blood pressure. Its use as intermittent bolus injections allowed better control of the dose and the hypotensive response which decreased the risk of unintentional hypotension. The reduction of blood pressure by labetalol preoperatively buffered the increase in blood pressure following tracheal intubation, as the blood pressure post-intubation in almost all the patients did not exceed the base line blood pressure. The lower peak blood pressure decreases the risk of hypertensive morbidity. However, the significant increase in blood pressure following tracheal intubation suggests that blockade of the adrenoreceptors did not occur in our patients.
Epidural anesthesia decreased the blood pressure gradually and no significant increase occurred after skin incision. Significant differences were present in the neonatal Apgar score at 1 minute, but not at 5 minutes.
So, we conclude that epidural anesthesia, in the absence of any contraindications as coagulation abnormalities, uncorrected hypovolemia or patient refusal is more effective than general anesthesia in controlling the blood pressure of the hypertensive parturient and avoids the swings in blood pressure due to tracheal intubation and surgical stimulation. Meticulous care should be taken to avoid sudden severe hypotension in these potentially hypovolemic patients which can compromise the uteroplaccental blood flow. Proper preanesthetic hydration and slow induction of the epidural blockade represent important features of optimal management.