Introduction: Preeclampsia is a clinical syndrome defined as the new onset of hypertension and 
proteinuria during the second half of pregnancy. Aim of the work: The main target of the current 
research is: to exploit the GABA mimetic and potentiating effect of intrathecal midazolam to 
ameliorate the glutamate mediated preecmlapsia induced neuronal excitotoxicity and cerebro-vasculer 
vasospasm assessed by blood flow vascular indices (pulsitility index, resistive index and mean flow 
velocity) in maternal MCA in case of sever preeclampsia. Patients and methods: The current study 
was planned to be double blind placebo controlled single center randomized prospective study in 
which 100 parturient ASA IIe with severe preeclampsia were recruited into 2 groups 50 ladies in each 
group scheduled for emergency C.S after obtaining approval of the local ethics committee of Faculty 
of Medicine, El-Minia University and informed written consent from parturients husband or next of
kin. Study was carried out from December 2017 to August 2018. Results: This prospective 
randomized double blind study included 100 parturient allocated in 2 groups, 50 cases in each. All 
studied groups received lumbar subarachnoid block by bupivacaine 0.5%12.5 mg + 1 mg midazolam 
in (M) group or 0.2 cm sterile saline 0.9% Nacl in (C) group. Recommendations: We recommend:
Future studies on midazolam impact over maternal MCA resistive indices should examine different.
1- Using intrathecal midazolam in the dose of 1 mg in cases of severe preeclampsia as an adjuvant to 
bupivacaine 0.5% in the dose of 12.5 mg. 2- Increasing frequency of TCD readings to be at the base, 
6h, 12h, 18h & 24hs to be more accurate. 3- Using TCD antenatal in the future studies to early pick up 
ladies that may develop preeclampsia.