title: Anesthetic management of neurosurgical procedures during pregnancy: a case series.
abstract: BACKGROUND
  Neurosurgical disorders are rare during pregnancy and challenge the anesthesiologist with conflicting anesthetic considerations and little evidence to guide decision-making. Our objective was to review the anesthetic management of pregnant patients undergoing intracranial neurosurgery at our institution and to describe the perioperative complications and outcomes.
  
  
  METHODS
  We used our institutional Discharge Abstract Database to identify patients assigned both neurological and obstetrical International Classification of Disease 10-A codes between April 1, 2001 and March 1, 2012. Pregnant patients who underwent intracranial neurosurgical procedures underwent a detailed chart review to extract demographic data and details about their anesthetic management and outcome.
  
  
  RESULTS
  Nine patients underwent full chart review with a median age of 28 (range, 17 to 35) years and a gestational age of 23 (range, 7 to 30) weeks. Patients underwent a craniotomy for vascular lesions (4), neoplasms (3), and traumatic brain injuries (2). One patient was hyperventilated (PaCO2 28 mmHg), and mannitol and furosemide were used in 6 and 3 patients, respectively, without complication. Maternal neurological outcomes were good in 5 patients (Glasgow Outcome Scale of >3), poor in 3 patients (Glasgow Outcome Scale 3), and 1 patient died. Fetal outcomes were good in 5 patients and poor in 4 patients (1 therapeutic abortion, 3 intrauterine fetal demises). All cases of fetal distress or demise were either remote or occurred before the anesthetic management.
  
  
  CONCLUSIONS
  Pregnant patients undergoing neurosurgery experience a high rate of morbidity and mortality. There were no adverse outcomes directly attributed to the use of osmotic diuretics and hyperventilation in our series.
authors.affiliation: *Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia †Department of Anesthesia, British Columbia's Women's Hospital ‡Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Pooya
authors.initials: P
authors.lastname: Kazemi
authors.forename: Giselle
authors.initials: G
authors.lastname: Villar
authors.forename: Alana M
authors.initials: AM
authors.lastname: Flexman
mesh_terms: D000293:Adolescent; D000328:Adult; D058109:Airway Management; D000758:Anesthesia / Q000379:methods*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004232:Diuretics