Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

Breitenbach, Vanessa; Wilson, David Henry

doi:10.1590/s0034-70942005000100011

Rev. Bras. Anestesiol.

2005

DOI: 10.1590/s0034-70942005000100011

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Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

Vanessa Breitenbach

David Henry Wilson²

Abstract: RESUMO intubação traqueal. As drogas utilizadas foram tiopental (250 mg), rocurônio (50 mg), fentanil (100 µg) e lidocaína (60 mg) por via venosa. A indução anestésica foi suave e mantida com isoflurano até o início do fechamento da pele da paciente, com mínimas alterações de seus sinais vitais e do recém-nascido, que recebeu índice de Apgar 8 e 9, no 1º e 5º m i n u t o s , r e s p e c t i v a m e n t e . A p a c i e n t e d e s p e r t o u precocemente, sem deficits neurológicos adicionais. CONCLUSÕES:

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Cited by 3 publications

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Goal Oriented Anaesthetic Management of a Pregnant Patient With Brain Tumor Posted for Emergency Caesarian Section and v-P Shunt

Shetty¹,

Y²

2014

jemds

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BACKGROUND AND OBJECTIVE: Pregnant women with brain tumors are uncommon; however pregnancy itself may aggravate the natural history of an intracranial tumor and may even unmask a previously unknown diagnosis. Small studies remain an important source of knowledge and experience and hence this study aims to highlight the major issues and provide an overview to the case of the pregnant patients with brain tumor posted for emergency caesarean section including pre-anaesthetic evaluation, patient counseling per operative management and follow up. PRESENTATION, DIAGNOSIS, MANAGEMENT: A 23years old G2P1L1 lady presented at 41 weeks gestation and was posted for emergency caesarean section, indication being postdated pregnancy with previous caesarean section. She reported of being diagnosed with a brain tumor 6months back and that she has been suffering from severe headache associated with right sided facial palsy and bilateral hearing loss with severe papilledema. She confessed of her economic constraints because of which she couldn't get operated for so long. Following consultation between the anaesthetist, obstetrician and the neurosurgeon it was decided to proceed with caesarean section followed by V-P shunting under general anaesthesia. Rapid sequence induction and intubation was performed and was maintained with isoflurane, titrated to maintain the stability of mean arterial pressure until extraction. A live 2.6kgs female child was born with apgar scores of 8 and 9 at 1 and 5 mins respectively. Following extraction 10U oxytocin was given intramuscularly and 10U run as infusion in ringers lactate. Intra-operative analgesia was administered after extraction. After completion of caesarean section V-P shunting was performed by the neurosurgeon during which propofol and dexmedetomedine infusions were used. Post-operative period was uneventful. DISCUSSION & CONCLUSION: Anaesthetic management of brain tumor in pregnant women is mainly reliant on doctor's personal experience as no evidence based guidelines are available. General anaesthesia using thiopentone, propofol, fentanyl, dexmedetomedine and titrated dose of isoflurane as used in our case were found to be safe with adequate hemodynamic stability and post-operative pain control. A team approach involving the anaesthetist, obstetrician, neonatologist and neurosurgeon is recommended for appropriate management of such parturient.

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Goal Oriented Anaesthetic Management of a Pregnant Patient With Brain Tumor Posted for Emergency Caesarian Section and v-P Shunt

Shetty¹,

Y²

2014

jemds

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Goal Oriented Anaesthetic Management for Caesarean Section in a Parturient With Pituitary Tumour

R¹,

Y²

2015

jemds

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BACKGROUND AND OBJECTIVE: Anesthesia for Pregnancy with pituitary tumours is a challenge to an Anesthesiologist, requires careful preoperative assessment and meticulous perioperative management to achieve optimal safety of mother and fetus. There are very limited studies in literature to guide the anaesthetic management of such patients. Here we report the successful Anaesthetic management of a parturient with pituitary tumour with epilepsy posted for emergency caesarean section. PRESENTATION, DIAGNOSIS, MANAGEMENT: A 25 year young woman, G2P1L1, a known epileptic, diagnosed with pituitary macroadenoma presented at 40 weeks of gestation with severe Oligohydramnios (AFI-4cm) was posted for an emergency caesarean section. Following consultation with the obstetrician, neonatologist and the neurosurgeon the decision was made to proceed with caesarean section under general anesthesia. Rapid sequence induction and intubation was performed with inj Thiopentone sodium and inj Rocuronium and was maintained with Isoflurane, titrated to maintain the stability of mean arterial pressure until extraction. A live 4. 25kgs male child was born with Apgar scores of 8 and 9 at 1 and 5 mins respectively. Following extraction 10U run as infusion in Ringers lactate. Intraoperative analgesia was administered after extraction. Dexmedetomedine infusion was used. Postoperative period was uneventful. DISCUSSION & CONCLUSION: Management of obstetric patients with pituitary tumour is complex, requiring knowledge of the physiological effects of pregnancy on tumour size and labour on intracranial pressure. General anesthesia combined with multimodal balanced analgesia is associated with a favorable outcome. General anaesthesia using Thiopentone, Fentanyl, Dexmedetomedine and titrated dose of Isoflurane was used in our case were found to be safe with adequate hemodynamic stability and postoperative pain control. A team approach involving the Anaesthethesiologist, obstetrician, neonatologist and neurosurgeon is recommended for appropriate management of such parturient.

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Anesthetic management of a parturient with active tuberculous meningitis

Rajagopalan

Palvadi²,

Mason³

2015

Glob Anaesth Perioper Med

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Tuberculous meningitis (TBM) results from the infection of the meninges and the cerebrospinal fluid with Mycobacterium tuberculosis. The diagnosis and treatment of TBM is challenging due to its protean manifestations. We present the anesthetic management of a parturient with advanced TBM in whom urgent cesarean delivery was performed due to a non-reassuring fetal status. The patient's disease course was remarkable for altered mental status, seizures, isoniazid-induced hepatitis and hydrocephalus requiring ventriculo-peritoneal shunt placement. General endotracheal anesthesia was successfully performed that resulted in the safe delivery of a live infant.

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Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

Cited by 3 publications

References 3 publications

Goal Oriented Anaesthetic Management of a Pregnant Patient With Brain Tumor Posted for Emergency Caesarian Section and v-P Shunt

Goal Oriented Anaesthetic Management of a Pregnant Patient With Brain Tumor Posted for Emergency Caesarian Section and v-P Shunt

Goal Oriented Anaesthetic Management for Caesarean Section in a Parturient With Pituitary Tumour

Anesthetic management of a parturient with active tuberculous meningitis

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