The pregnant patient with an intracranial arteriovenous malformation. Cesarean or vaginal delivery using regional or general anesthesia?
OBJECTIVE
A parturient with large intracranial arteriovenous malformation presented for elective cesarean delivery.


METHODS
The anesthetic technique included acute hydration with intravenous crystalloid followed by continuous epidural anesthesia with bupivacaine and fentanyl and oxygen by face mask. Intraoperative monitoring consisted of electrocardiography, pulse oximetry, invasive arterial blood pressure, and analysis of arterial blood gases. Postoperative analgesia in the immediate postoperative period was provided by a continuous epidural infusion of bupivacaine and fentanyl followed by intravenous patient-controlled analgesia using a mixture of morphine and droperidol.


RESULTS
A cesarean delivery was successfully performed and both mother and infant were eventually discharged from the hospital in good condition.


CONCLUSIONS
In this case report the choice of obstetric management (cesarean versus vaginal delivery) of a full-term parturient with an intracranial arteriovenous malformation is discussed, and the rationale for the preference of epidural anesthesia for the cesarean delivery is presented.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
S K
SK
Sharma
E R
ER
Herrera
J E
JE
Sidawi
K J
KJ
Leveno
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000765:Anesthesia, Conduction; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D000077324:Crystalloid Solutions; D036861:Delivery, Obstetric; D004329:Droperidol / Q000008:administration & dosage; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005440:Fluid Therapy; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000503:physiopathology*; D007552:Isotonic Solutions; D009020:Morphine / Q000008:administration & dosage; D010952:Plasma Substitutes / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*; D015532:Rehydration Solutions / Q000627:therapeutic use
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions; D009020:Morphine; D004329:Droperidol; D005283:Fentanyl; D002045:Bupivacaine