Viroj Wiwanitkit*Hainan Medical University, Wiwanitkit House, Bangkhae, Bangkok, Thailand
*Corresponding author: Viroj Wiwanitkit, Hainan Medical University, Wiwanitkit House, Bangkhae, Bangkok Thailand, E-mail: email@example.com
Article Type: Short Commentary
Citation: Wiwanitkit V (2017) Preeclampsia and Intra-Abdominal Hypertension. J Clin Anesth Manag 2(2): doi http://dx.doi.org/10.16966/2470-9956.132
Copyright: © 2017 Wiwanitkit V. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Preeclampsia is an important obstetric disorder. This disease becomes an important problem for many pregnant women and it can result in severe clinical problems including to death. Marshalov et al. reported their interesting findings and proposed that “The results of our research present the first multi-factorial model of preeclampsia etiology, where the trigger mechanism is the abdominal hypertension syndrome .” In fact, the exact etiology of preeclampsia is still unknown and it is believed to be a multifactorial disease. The underlying vascular problem is usually mentioned as important factor . The hypothesis on the intra-abdominal hypertension induced preeclampsia is a new hypothesis proposed by Sawchuck et al., . This concept is based on the basic physical mechanics on the pressure rule . The intra-abdominal hypertension can be expected in any pregnant women who have significantly changes of abdominal cavity due to increasing size of uterus when the gestational age of the fetus increases. If we apply the concept of management of the intraabdominal hypertension, relieving of the pressure, which is the important factor causing organ failure, should be urgently done . This concept is concordant with classical gynecological principle for management of severe preeclampsia and eclampsia by termination of pregnancy. An “applied negative abdominal pressure device” is also proposed for management of preeclampsia .
For anesthesiology, the interesting question is “what should we concern if preeclampsia is an actual disease caused by intra-abdominal hypertension?”. For intra-abdominal hypertension in obstetric anesthesiology, Tyagi et al. noted that “Normalization of intra-abdominal pressure after delivery was associated with better survival .” And “There was no correlation between intra-abdominal pressure and organ function or mortality .” Also, it was recently approved that spinal anesthesia is not problematic in the patient with intra-abdominal hypertension . Hence, using spinal anesthesia for ceasrian section in case with pre-eclampsia should be safe. The major risk to be concern for anesthesia in any patients with intra-abdominal hypertension, which should include preeclampsia, is the development of respiratory problem . Special precaution should be raised for prevention of aspiration and the good preparation of mechanical ventilation is required . Whether the preeclampsia is an actual disease caused by intra abdominal hypertension or not, the application of the basic anaethesiological considerations for management of patients with intra abdominal hypertension can be useful for clinical management of the patients with preeclampsia undergone obstetric procedures.
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