General Anesthesia for Surgical Repair of Intracranial Aneurysm in Pregnancy: Effects on Fetal Heart Rate

Abstract

A 30-year-old nulliparous woman underwent surgery for a ruptured aneurysm of the left vertebral artery in gestational week 27. The fetal heart rate (FHR) was monitored continuously with an abdominal Doppler transducer. Anesthesia was induced with midazolam, fentanyl, and thiopental and maintained with fentanyl, isoflurane, and nitrous oxide 67% in oxygen. Surgery was performed under moderate hypotension (mean arterial pressure +/- 70 mmHg) and moderate hyperventilation (arterial carbon dioxide pressure +/- 33 mmHg). There was a complete disappearance of FHR variability without decelerations or bradycardia. In the night following surgery, the patient was sedated with large parenteral doses of midazolam and fentanyl. Despite this sedation, some FHR variability reappeared within 40 minutes after discontinuation of the inhalation anesthetics. After discontinuation of parenteral midazolam and fentanyl, normal FHR variability returned within 60 minutes. In week 41 of pregnancy, a healthy girl of 4015 gm was born.

Subarachnoid hemorrhage due to cerebral aneurysmal rupture during pregnancy

“…Cerebral aneurysmal complications occur exceptionally during pregnancy and have generally been reported in the literature in the form of a case report (1–11). Their low frequency may be explained by the mean age of aneurysmal rupture in women, which is approximately the age of 50 (12,17).…”

“…It would be impossible to decide on a dominant carotid topography in pregnancy based on only eight cases and this remains to be confirmed by a large retrospective study. However, we reviewed other pregnant cases presented in the past 17 years' literature and we found that seven cases out of 14 described an ICA aneurysm (2–10).…”

“…Only a few authors have suggested that aneurysmal occlusion should precede delivery because of a major patient risk (4,7). In our experience a rapid cesarean section can usually be carried out prior to surgical or IVE treatment except, possibly, in patients presenting high intracranial pressure due to a compressive cerebral hematoma requiring its evacuation in an emergency (21).…”

“…The frequency of subarachnoid hemorrhage (SAH) due to cerebral aneurysmal rupture has been reported as being between 1/1100 and 1/25 000 pregnancies (1–11). In the general population this frequency ranges from 6 to 16/100 000 (12).…”

Endovascular Treatment in Pregnancy

“…49) However, cesarean delivery has several limitations in the angiographic suite with limited equipment. A hybrid operating room equipped with a full-spec digital subtraction angiography machine is considered to be useful.…”