[Anesthetic managements for emergency cesarean section and craniotomy in patients with intracranial hemorrhage due to ruptured cerebral aneurysm and arteriovenous malformation].
We report two cases of anesthetic management for emergency cesarean sections and craniotomies in patients with intracranial hemorrhage. Case 1: A 32-year-old woman at 33 weeks gestation suffered from subarchnoid hemorrhage due to the rupture of cerebral aneurysm. Case 2: A 38-week-pregnant woman aged 32 developed intracerebral hematoma resulting from ruptured arteriovenous malformation. The weights of the fetuses were estimated to be 1756 g and 1996 g respectively, and they were expected premature. Discussions with obstetricians, neurosurgeons and neonatologists encouraged us to schedule cesarean section followed by craniotomy under general anesthesia. Before deliveries we selected isoflurane and avoided excessive hyperventilation to maintain uteroplacental circulation. After deliveries, isoflurane was changed to propofol and prostaglandin E1 was infused to control blood pressure and to avoid uterine atonic bleeding. Uneventful anesthetic course resulted in both the mothers and the fetuses surviving. It is important to develop good relationships among the specialists for the management of pregnant woman with intracranial hemorrhage.
Nagamine
Norimitsu
N
Division of Anesthesiology, Yamanashi Prefectural Central Hospital, Kofu 400-0027.
Shintani
Noriyuki
N
Furuya
Atsushi
A
Suzuki
Satomi
S
Nonaka
Akihiko
A
Abe
Fumiaki
F
Matsukawa
Takashi
T
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D017542:Aneurysm, Ruptured / Q000150:complications*; D002585:Cesarean Section; D003399:Craniotomy; D004630:Emergencies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications; D016896:Treatment Outcome