title: Intraoperative fetal heart rate monitoring during emergency neurosurgery in a parturient.
abstract: Malignant brain tumors during pregnancy are rare, and these patients seldom require immediate surgical intervention. A 27-year-old pregnant woman underwent emergency craniotomy. Anesthesia was induced with intravenous thiopental-fentanyl; it was maintained with isoflurane in oxygen and continuous intravenous remifentanil infusion. We used full stomach precautions but omitted succinylcholine for fear of increasing the intracranial pressure during induction of anesthesia. To detect fetal hypoxia and the effects of anesthesia on fetal hemodynamics, the fetal heart rate (FHR) was monitored using a fetal Doppler ultrasonography unit fixed to the mother's abdominal wall. Intraoperative and recovery periods were uneventful. Use of an isoflurane and remifentanil combination provided stable hemodynamics with adequate arterial blood pressure to avoid uterine hypoperfusion and fetal hypoxia. In this case, using FHR monitoring we found that craniotomy can be performed safely under isoflurane/remifentanil based-general anesthesia during the second trimester of pregnancy.
authors.affiliation: Department of Anesthesiology and Reanimation, Izmir Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Bahattin
authors.initials: B
authors.lastname: Tuncali
authors.forename: Murat
authors.initials: M
authors.lastname: Aksun
authors.forename: Kaan
authors.initials: K
authors.lastname: Katircioglu
authors.forename: Ismail
authors.initials: I
authors.lastname: Akkol
authors.forename: Serdar
authors.initials: S
authors.lastname: Savaci
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D016343:Monitoring, Intraoperative; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*