Impact of adding midazolam to bupivacaine 0.5% in regional spinal anesthesia on maternal middle cerebral artery velocimetry  in parturients with severe preclampsia

Severe preclampsia is a challenging issue facing both intensivist and anesthetic team carrying both maternal and fetal morbidity and mortality. Termination of pregnancy after blood pressure control is the golden key in management. Cerebral complications due to diffuse cerebral vasospasm are most common and serious. Intrathecal midazolam with its gamma amino butyric action may antidote glutamate mediated sympathetic surge and decreasing cererbral vasospasm. Temporal view transcranial doppler imaging maternal middle cerebral artery is used to examine Blood flow indices namely pulsatality index and resisitive index. One hundered Ladies with severe preclampsia scheduled for urgent caeserian section were recruited in 2 groups, both received 10mg bupivacaine 0.5%, Midazolam group received 1mg midazolam and the other group received 0.2ml sterile saline 0.9% NaCl. All vascular indices were significantly better in midazolam group, less ICU stay.