Use of norepinephrine for urgent cesarean delivery under spinal anesthesia in parturients with severe preeclampsia: A report of 2 cases

Spinal anesthesia for severe preeclampsia was once thought contraindicated because of refractory hypotension. Contrary to the conventional belief clinical studies revealed that the incidence of hypotension in these patients was fewer than expected, and spinal anesthesia has gradually become the standard method for these patients. However, we experienced two severe preeclampsia cases requiring norepinephrine infusion to maintain blood pressure during cesarean delivery under spinal anesthesia Case 1 : A 40-year-old primigravida with severe preeclampsia underwent urgent cesarean delivery due to uncontrollable hypertension and non-reassuring fetal status. Spinal anesthesia was induced without abrupt hypotensioa but her blood pressure significantly dropped after the delivery of the infant Norepinephrine infusion (200 μg • hr-1) was initiated, and her blood pressure was normalized Case 2 : A 33-year-old primigravida with severe preeclampsia underwent urgent cesarean delivery due to progressive thrombocytopenia and symptomatic pulmonary edema Combined spinal epidural anesthesia was induced, and she developed refractory hypotension with dyspnea after the delivery of the infant Norepinephrine infusions and continuous positive airway pressure were commenced, which improved her symptoms. Conclusion : Refractory hypotension can occur not only after the induction of spinal anesthesia but also after the delivery. Management strategy should be based on individual patient's hemodynamic profile.