BACKGROUND: Epidural anesthesia is thought to be relatively indicated for cesarean section in patients with severe preeclampsia. In contrast, avoidance of spinal anesthesia is recommended, postulating excessive hypotensive risks. In addition, general anesthesia is often avoided in this population because malignant hypertension following tracheal intubation is common and risks for difficult airway management are excessive. METHODS: In this study, we compared hemodynamic changes in patients with severe preeclampsia and normal pregnant women during spinal anesthesia for elective cesarean section. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine mixed with 25 microgram fentanyl in 18 patients with severe preeclampsia and 17 normal pregnant women. We compared MAP, CI, and SVRI changes before and after spinal anesthesia. RESULTS: MAP responses following induction of spinal anesthesia for elective cesarean section in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. CI responses following induction of spinal anesthesia in patients with severe preeclampsia showed a statistically significant increase from 8 min after and normal pregnant women also showed a statistically significant increase from 4 min after spinal anesthesia. SVRI responses from induction of spinal anesthesia in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. Incidence of hypotension before delivery and used total dose of ephedrine during operation were statically insignificant between severe preeclamptic and normal pregnant women. CONCLUSIONS: We conclude that changes of MAP, CI and SVRI following spinal anesthesia for elective cesarean section in the severely preeclamptic and normal pregnant women are clinically similar. We suggest that spinal anesthesia for cesarean section is not contraindicated in the severely preeclamptic patient.