Anesthetic management of combined emergency cesarean section and craniotomy for intracerebral hemorrhage in a patient with severe pre-eclampsia

Roopa, S; Hegde, Harihar V; Torgal, Shrirang V.; Melkundi, Sateesh; Sunita, T H; Mudaraddi, Rajashekar; Rao, P Raghavendra

doi:10.1016/j.cacc.2010.06.001

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…In this case, the authors did not use magnesium sulfate, which could have had a favorable effect on hemodynamic stability. [ 23 ] Our case is a prime example supporting early initiation of therapy with magnesium sulfate. It has been proposed that magnesium sulfate may prevent vasospasm by acting as a calcium antagonist.…”

Section: Discussionmentioning

confidence: 90%

“…Even though there are two reports in the literature, with similar clinical presentations, our case is unique because the patient developed ICH only a couple of hours after the first recordings of elevated BP. [ 4 23 ] In one case, the patient had preeclampsia superimposed on chronic hypertension, where at 34 weeks of pregnancy she presented with a BP of 165/100 mmHg. She received nifedipide and magnesium sulfate to control the event.…”

Section: Discussionmentioning

confidence: 99%

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Complete recovery after antepartum massive intracerebral hemorrhage in an atypical case of sudden eclampsia

Ghaly¹,

Candido²,

Sauer³

et al. 2012

Surg Neurol Int

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Background:Intracerebral hemorrhage is an infrequent but severe complication in pregnant women with hypertension.Case Description:We describe an atypical case of a patient with no risk factors who developed sudden eclampsia and spontaneous intracerebral hemorrhage during the 34th week of pregnancy. She underwent successful emergent Cesarean section followed by craniotomy. Both intraoperative surveillance and postoperative magnetic resonance angiographic examination of the cerebral vessels failed to identify an aneurysm, arteriovenous malformation, tumor, or leptomeningeal disease.Conclusion:We discuss the management of this case and review the literature regarding the threshold for which initiation of antihypertensive treatment is indicated in pregnant patients.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Complete recovery after antepartum massive intracerebral hemorrhage in an atypical case of sudden eclampsia

Ghaly¹,

Candido²,

Sauer³

et al. 2012

Surg Neurol Int

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“…Anesthetic management in unconscious eclamptic patients may present several dilemmas including rapid sequence induction while blocking the stress responses to laryngoscopy, drug interaction between magnesium sulfate with muscle relaxant, regarding use of internal jugular cannulation with brain edema and the risk of laryngeal edema presenting as difficult airway. [ 7 8 ] Until now, only two cases of successful management in eclamptic patient with intracerebral hemorrhage by craniotomy with cesarean section had been reported. [ 8 9 ] The importance of early clinical and radiological assessment of the central nervous system in eclampsia patient with a sudden decrease in conscious level has also been emphasized.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 8 ] Until now, only two cases of successful management in eclamptic patient with intracerebral hemorrhage by craniotomy with cesarean section had been reported. [ 8 9 ] The importance of early clinical and radiological assessment of the central nervous system in eclampsia patient with a sudden decrease in conscious level has also been emphasized. [ 10 ] We report the first case of eclamptic patient with IVH, which was successfully managed by timely diagnosis and conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

Management of atypical eclampsia with intraventricular hemorrhage: A rare experience and learning!

Gupta

Goyal

2015

Anesth Essays Res

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Cerebrovascular accident during hypertensive disorder of pregnancy is a rare entity, but carries high risk of mortality and morbidity due to its unpredictable onset and late diagnosis. Here, we report an unusual case of 20-year-old primigravida with 34 weeks gestation having no risk factor, which developed sudden atypical eclampsia and intracranial hemorrhage within few hours. She was successfully managed by multidisciplinary approach including emergency cesarean section and conservative neurological treatment for intraventricular hemorrhage.

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“…General anaesthesia is often thought to be unsafe because of several maternal airway-related factors, such as possible difficult airways, failed intubation, and hypertensive response to laryngoscopy and intubation 5 . However, under certain circumstances, general anaesthesia may be indicated for emergent CS, such as in cases that require a reassuring airway and for patients with severe coagulopathy 6 . By contrast, reports have claimed that spinal anaesthesia (SA) is associated with less hypotension and less impairment of cardiac function in preeclamptic patients compared with that in healthy patients 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

A systematic review with network meta-analysis on mono strategy of anaesthesia for preeclampsia in caesarean section

Cheng

Liao

Chen

et al. 2021

Sci Rep

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The aim of this study was to reveal the effects of anaesthesia strategies on maternal mean arterial pressure (MAP), heart rate, vasopressor consumption, adverse events, and neonatal resuscitation when women with preeclampsia (PE) undergo caesarean section (CS). Three major databases were searched for randomized controlled trials (RCTs) and prospective controlled studies (PCSs). Two authors independently screened, extracted, and checked eligibility and outcome data. Outcomes involved MAP, vasopressor use, maternal adverse events, APGAR scores, and neonatal resuscitation. Pooled estimates were carried out by contrast-based network meta-analysis, and pooled effect sizes were presented with 95% confidence interval (CI). Eleven RCTs and one PCS (n = 782) formed three-node network meta-analysis, and non-significant differences were observed in MAP, 5-min APGAR score, and neonatal intubation rate among the three anaesthesia strategies. General anaesthesia had significantly lower vasopressor consumption than spinal anaesthesia did (standardised mean difference = − 1.19, 95% confidence interval [CI]: − 1.76 to − 0.63), but it had higher maternal adverse event rate (risk ratio = 2.00, 95% CI 1.16–3.47). Because no optimal anaesthesia strategy has been shown to achieve a balanced maternal and neonatal outcome, therefore a shared decision-making process may be required regarding the most suitable choice of anaesthetic strategy for individual preeclamptic mother undergoing CS. Future larger studies may need to focus on evaluating the role of vasopressors on maternal hemodynamic as well as factors affecting maternal outcomes for different anaesthetic techniques in preeclamptic women undergoing CS.

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Anesthetic management of combined emergency cesarean section and craniotomy for intracerebral hemorrhage in a patient with severe pre-eclampsia

Cited by 5 publications

References 17 publications

Complete recovery after antepartum massive intracerebral hemorrhage in an atypical case of sudden eclampsia

Complete recovery after antepartum massive intracerebral hemorrhage in an atypical case of sudden eclampsia

Management of atypical eclampsia with intraventricular hemorrhage: A rare experience and learning!

A systematic review with network meta-analysis on mono strategy of anaesthesia for preeclampsia in caesarean section

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