ANESTHETIC MANAGEMENT OF SEVERE PREECLAMPSIA: STRATEGIES FOR HEMODYNAMIC CONTROL, AIRWAY SAFETY AND PREVENTION OF MATERNAL COMPLICATIONS

Abstract

Severe preeclampsia is one of the major obstetric conditions associated with maternal morbidity and mortality, particularly when accompanied by severe hypertension, neurological, renal, hepatic, hematological, cardiovascular, or pulmonary dysfunction. Anesthetic management requires individualized assessment and close integration among obstetrics, anesthesiology, intensive care, and neonatology teams. This study aimed to analyze the main anesthetic strategies used in the management of pregnant women with severe preeclampsia, focusing on hemodynamic control, airway safety, and prevention of maternal complications. A narrative literature review was conducted using PubMed/MEDLINE, Cochrane Library, SciELO, and Embase, employing descriptors related to preeclampsia, obstetric anesthesia, severe hypertension, airway management, neuraxial anesthesia, magnesium sulfate, and hemodynamic monitoring. After application of eligibility criteria and assessment of relevance, 32 scientific studies and documents were included in the final synthesis, with priority given to publications from 2020 to 2026. Current evidence indicates that neuraxial anesthesia remains an important strategy when there are no contraindications related to coagulation abnormalities or maternal clinical status, whereas general anesthesia presents specific challenges involving airway edema, difficult intubation, and hypertensive responses to laryngoscopy. Strict blood pressure control, appropriate vasopressor use, cautious fluid administration, seizure prevention with magnesium sulfate, and individualized coagulation assessment are essential components of care. In conclusion, early multidisciplinary anesthetic planning is fundamental to reducing cerebrovascular, cardiovascular, respiratory, and hemorrhagic complications and improving maternal and fetal safety.