Comparison of Regional and General Anesthesia in Eclampsia Patients Undergoing Caesarean Section: A Literature Review

Abstract

Eclampsia is a life-threatening obstetric emergency requiring prompt delivery and careful anesthetic management during cesarean section. This literature review aimed to compare the safety and effectiveness of regional anesthesia, particularly spinal anesthesia, with general anesthesia in patients with preeclampsia or eclampsia undergoing cesarean section. A narrative literature review was conducted using articles retrieved from PubMed, Google Scholar, ScienceDirect, and other relevant scientific sources. Articles published between 2018 and 2025 that examined maternal hemodynamic parameters and maternal or neonatal outcomes were included. Sixteen original studies with prospective, retrospective, observational, comparative, cohort, cross-sectional, and randomized designs were reviewed. Overall, spinal anesthesia was associated with more controlled intraoperative hemodynamics, fewer postoperative maternal complications, reduced intensive care requirements, shorter hospitalization, and better neonatal outcomes than general anesthesia. Although hypotension occurred in approximately 47–50% of patients receiving spinal anesthesia, it was generally transient and manageable with vasopressors. In contrast, general anesthesia was more frequently associated with hypertensive responses during laryngoscopy and intubation, pulmonary edema, renal complications, postoperative seizures, and delayed recovery. Neonates delivered under spinal anesthesia generally had higher first- and fifth-minute APGAR scores, lower rates of neonatal asphyxia, and reduced neonatal intensive care requirements. In conclusion, spinal anesthesia demonstrates a more favorable maternal and neonatal safety profile and should be considered the preferred technique when no contraindications are present. General anesthesia remains necessary in patients with severe thrombocytopenia, impaired consciousness, coagulation disorders, airway concerns, or clinical conditions requiring immediate airway control and rapid delivery.