Journal of neurosurgical anesthesiology · 2014
Anesthetic management of neurosurgical procedures during pregnancy: a case series.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Kazemi Pooya, Villar Giselle, Flexman Alana M
Аннотация
INTRODUCTION: 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.
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.