[Dexmedetomidine in general anesthesia for surgical treatment of cerebral aneurysm in pregnant patient with specific hypertensive disease of pregnancy: case report.].
OBJECTIVE
The incidence of non-obstetrical surgeries in pregnant patients is about 0.36% to 2%. However, surgeries aiming at surgical treatment of cerebral aneurysm in pregnant women are extremely rare. Specific hypertensive disease of pregnancy, shows clinical prevalence of 10%. It is a disease with high clinical complexity compromising multiple organs and systems. Dexmedetomidine, alpha2-adrenoceptor agonist drug, in therapeutic clinical doses has major selectivity for these receptors and promotes suitable hemodynamic stability if used in the preoperative period. The purpose of this report was to present an anesthetic technique able to provide adequate maintenance of maternal homeostasis, preserving to the highest level uterus-placental blood flow and fetal vitality, without neglecting fundamental aspects regarding the optimization of brain oxygen supply/demand ratio and favorable brain tissue conditions for surgical management.


METHODS
Pregnant patient, 19 years old, 27 weeks of gestation, was referred to the operating room for surgical treatment of cerebral aneurysm. In the preoperative period she was conscious, oriented, eupneic but with left side motor deficit and clinical signs compatible with toxemia of pregnancy. Dexmedetomidine (1 microg.kg-1.h-1) was administered in 20 minutes, followed by anesthetic induction with propofol (2.5 mg.kg-1), fentanyl (7.5 microg.kg-1), lidocaine (1 mg.kg-1) and rocuronium (1.2 mg.kg-1) in rapid sequence. Anesthesia was maintained with propofol (50 microg.kg-1.min-1), alfentanil (1 microg.kg-1.min-1) and dexmedetomi- dine (0.7 microg.kg-1.h-1). Surgical procedure went on with no complications, including brain sequelae.


CONCLUSIONS
This case report has shown that dexmedetomidine made possible the handling of hemodynamic responses, keeping optimized uterus-placental blood flow and fetal vitality. Adequate conditions of surgical brain tissue manipulation and the absence of influence in postoperative morbidity are also emphasized.
Souza
Kleber Machareth de
KM
Serviço de Anestesiologia, Santa Casa de Campo Grande.
Anzoategui
Luiz César
LC
Pedroso
Washington Cássio Justino
WC
Gemperli
Werner Alfred
WA