Anesthetic management of cerebral aneurysm clipping during pregnancy: a case report.
A 35-week pregnant female presented emergently for clipping of a cerebral aneurysm under general anesthesia. The patient was neurologically stable with an active fetus. Anesthetic goals for this patient included maintenance of uteroplacental perfusion, fetal well-being, and maternal well-being. Maternal monitoring consisted of invasive arterial blood pressure, central venous pressure, and urine output, in addition to the standard monitors for anesthesia. Fetal monitoring consisted of fetal heart rate by external Doppler and uterine activity by external tocometer. Anesthesia care was directed at ensuring optimal maternal and fetal well-being. The aneurysm was clipped, and the patient emerged from anesthesia without neurological deficits. No uterine activity was noted intraoperatively. Fetal heart rate was maintained between 125 and 160 beats per minute. A healthy baby was delivered 11 days postoperatively by cesarean section under regional anesthesia. The Apgar score was 8/9 at 1 and 5 minutes.
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D000328:Adult; D000769:Anesthesia, Inhalation; D005260:Female; D005311:Fetal Hypoxia / Q000517:prevention & control; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D002532:Intracranial Aneurysm / Q000601:surgery*; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*