الفهرس 
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Abstract
The present study was accomplished to compare three different anesthetic modalities used randomly for severely preeclamptic parturients with gestational age ≥ 37 weeks scheduled for caesarean delivery at the Mansoura University
Hospital. Preoperative management consisted of clinical examination, laboratory investigations, arterial blood pressure control by hydralazine, MgSo4 for seizures prophylaxis and 500 mL fluid bolus of 6% hydroxyethyl starch.
Parturients were randomized to one of three groups (n= 25 in each):
1. General: induced by rapid sequence induction followed by maintenance with sevoflurane. Stress response to intubation and extubation was attenuated using i.v. 2% lidocaine .
2. Spinal: with 5mg heavy bupivacaine plus fentanyl.
3. Epidural: using 2% lidocaine and fentanyl.
The primary maternal outcome was the intraoperative changes in maternal haemodynamics in each group. Maternal haemodynamics remained within acceptable levels without excessive increase in blood pressure in general anaesthesia group or decrease in the regional groups. Regional anaesthesia induced hypotension was managed without excessive i.v. fluids or vasopressor administration. Uterine VAS I was significantly decreased in the general anaesthesia group compared to the other two groups. Times from induction to skin incision and from induction to delivery were statistically significantly longer in the epidural group compared to the other two groups in which these intervals were comparable to each other. Intraoperative pain was recorded in two patients in the epidural group while in the spinal group, none of the patients developed intraoperative pain. Neonatal outcome was assessed using Apgar score, NACS and neonatal weight. There were no significant differences among the study groups apart from the statistically significant decrease in 1 min Apgar score in the general anaesthesia group compared to the other two groups.
No serious maternal or fetal complications occurred with the use of any anaesthetic techniques.