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Anesthesia for cesarean section in two patients with brain tumours
L Chang1, L Looi-Lyons, L Bartosik
1Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
Summary
General anesthesia is safe for cesarean delivery in pregnant patients with brain tumors, even in emergencies. This approach allows for controlled ventilation to manage intracranial pressure and maintain hemodynamic stability for successful outcomes.
Area of Science:
- Neuroanesthesia
- Obstetric Anesthesia
- Neurosurgery
Background:
- Intracranial tumors in pregnancy present complex anesthetic challenges.
- Cesarean delivery in these patients requires careful management of maternal and fetal well-being.
Observation:
- Two cases are presented: one emergency cesarean section with simultaneous craniotomy for acute intracranial tumor herniation, and one urgent cesarean section in a patient with a history of brain tumor and elevated ICP.
- General anesthesia was successfully employed in both cases, with specific anesthetic agents and techniques tailored to maintain maternal and fetal well-being.
Findings:
- General anesthesia with tracheal intubation facilitated controlled maternal hyperventilation, effectively reducing ICP.
- Hemodynamic stability was maintained throughout the procedures, ensuring adequate cerebral perfusion.
- Both mothers delivered healthy infants, and neurosurgical intervention was ultimately not required in the second case.
Implications:
- General anesthesia is a safe and reliable option for operative delivery in parturients with intracranial tumors.
- Controlled ventilation during general anesthesia is a key strategy for managing elevated ICP.
- A multidisciplinary team approach is crucial for optimizing patient outcomes in these complex cases.