Anesthesia for Neurosurgery in the Pregnant Patient

Wlody, David; Weems, Lela

doi:10.1016/b978-0-323-05908-4.10028-4

Cited by 11 publications

(32 citation statements)

References 90 publications

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“…Some concerns have been raised regarding risk of developing fetal hyperosmolarity and hypernatraemia; however there is no evidence that mannitol, in the dose range of 0.5-1.0 g/kg, has any clinically significant effect on fetal fluid balance. 24 Tachycardia caused by slow i.v. oxytocin is usually well tolerated by patients with mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Infective endocarditis complicated by rupture of intracranial mycotic aneurysm during pregnancy

Trivedi

Carroll

Rutherford

2008

International Journal of Obstetric Anesthesia

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Section: Discussionmentioning

confidence: 99%

Infective endocarditis complicated by rupture of intracranial mycotic aneurysm during pregnancy

Trivedi

Carroll

Rutherford

2008

International Journal of Obstetric Anesthesia

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“…Modest maternal hyperventilation to achieve an EtCO 2 of 28-30 mmHg to decrease cerebral volume may also be done if more surgical exposure is required. [11][12][13]…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management for combined emergency caesarean section and craniotomy tumour removal

Bisri

Wullur

Bisri

2017

Journal of Neuroanaesthesiology and Critical Care

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Presentation of primary intracranial tumour during pregnancy is extremely rare. Symptoms of brain tumour include nausea, vomiting, headache and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. In very few cases, craniotomy tumour removal is performed earlier or even simultaneously with foetal delivery. A 40-year-old woman at 32 weeks of gestation in foetal distress presented to the emergency room with decreased level of consciousness Glasgow Coma Scale 6 (E2M2V2). Computed tomographic scan revealed a mass lesion over the left temporoparietal region with midline shift and intratumoural bleeding. In view of high risk of herniation and foetal distress, she underwent emergency caesarean section followed by craniotomy tumour removal. In parturient with brain tumour, combined surgery of tumour removal and caesarean section is decided based on clinical symptoms, type of tumour and foetal viability. Successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of mother and foetus.

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“…Brain tumours tend to increase in size during pregnancy due to several factors such as fluid retention, increased blood volume and hormonal changes and therefore may be diagnosed earlier 5 . The decision to proceed with neurosurgery during pregnancy depends on the site, size, type of tumour, neurological signs and symptoms, age of the foetus, and the patient’s wishes 6, 7 .…”

Section: Discussionmentioning

confidence: 99%

A case series discussing the anaesthetic management of pregnant patients with brain tumours

et al. 2013

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Pregnancy may aggravate the natural history of an intracranial tumour, and may even unmask a previously unknown diagnosis. Here we present a series of seven patients who had brain tumours during pregnancy. The aim of this case series is to characterize the current perioperative management and to suggest evidence based guidelines for the anaesthetic management of pregnant females with brain tumours. This is a retrospective study. Information on pregnant patients diagnosed with brain tumours that underwent caesarean section (CS) and/or brain tumour resection from May 2003 through June 2008 was obtained from the Department of General Anaesthesia and the Rose Ella Burkhardt Brain Tumour & Neuro-Oncology Centre (BBTC) at the Cleveland Clinic, OH, USA. The mean age was 34.5 years (range 29-40 years old). Six patients had glioma, two of whom had concomitant craniotomy and CS. Six cases had the tumour in the frontal lobe. Four cases were operated on under general anaesthesia and three underwent awake craniotomy. The neonatal outcomes of the six patients with elective or emergent delivery were six viable infants with normal Apgar scores. Pregnancy was terminated in the 7th patient. In conclusion, management of brain tumours in pregnant women is mainly reliant on case reports and the doctor's personal experience. Therefore, close communication between the neurosurgeon, neuroanaesthetist, obstetrician and the patient is crucial. General anaesthesia, propofol, dexmedetomidine and remifentanil were used in our study and were safe. Although this may not agree with previous studies, desflurane and isoflurane were used in our patients with no detectable complications.

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Anesthesia for Neurosurgery in the Pregnant Patient

Cited by 11 publications

References 90 publications

Infective endocarditis complicated by rupture of intracranial mycotic aneurysm during pregnancy

Infective endocarditis complicated by rupture of intracranial mycotic aneurysm during pregnancy

Anaesthetic management for combined emergency caesarean section and craniotomy tumour removal

A case series discussing the anaesthetic management of pregnant patients with brain tumours

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