Neuro-anesthesiology in pregnancy

Bernstein, Kyra; Hussey, Hanna; Hussey, Patrick; Gordo, Kaila; Landau, Ruth

doi:10.1016/b978-0-444-64239-4.00010-2

Cited by 8 publications

(10 citation statements)

References 80 publications

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“…Postoperatively, the patient should be nursed in the NCU for optimisation of haemodynamics and cerebral resuscitation 18 19. The fetal well-being should be managed by the obstetrician by monitoring the FHB and ultrasonography 20.…”

Section: Discussionmentioning

confidence: 99%

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

et al. 2023

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Intracranial malignancy among pregnant women is extremely rare. Neuroanaesthesia for such high-risk patients demands extreme precautions. Our patient presented with a huge right cerebellopontine angle meningioma during the first trimester of her pregnancy. We share our valuable perianaesthetic challenges in managing her tumour-debulking surgery and a brief review of intracranial neoplasm during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

et al. 2023

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“…Insiden maternal stroke, bisa berupa strok iskemik (SI) atau strok hemoragik (SH), diperkirakan 30 dari 100.000 kehamilan dan termasuk perdarahan intraserebral nontraumatic (intracranial hemorrhage/ICH) dan perdarahan subarakhnoid (subarachnoid hemorrhage/SAH), trombosis sinus dural, dan trombosis vena serebral (cerebral venous thrombosis/CVT). [1][2][3] Strok hemoragik disebabkan oleh pendarahan ke otak karena pecahnya pembuluh darah. Strok hemoragik dapat dibagi lagi menjadi perdarahan intraserebral (ICH) dan perdarahan subaraknoid (SAH).…”

Section: Pendahuluanunclassified

“…Wanita hamil yang diduga menderita SI atau SH harus dievaluasi untuk terapi yang sama dengan wanita yang tidak hamil, dan perawatan multidisiplin segera dilakukan untuk menghindari keterlambatan dalam mengelola keadaan darurat ibu. 1,2 Pendarahan otak dapat dilihat dalam hubungannya dengan preeklampsia berat, SAH dapat terjadi selama kehamilan karena ruptur aneurisma atau ruptur malformasi arteriovenosa. Tekanan darah selama kehamilan, persalinan, dan periode postpartum dini dapat memicu terjadinya perdarahan subaraknoid.…”

Section: Pendahuluanunclassified

“…Data menunjukkan bahwa wanita hamil dengan hipertensi gestasional memiliki risiko terjadi ICH 2,73 kali lebih tinggi dibandingkan dengan mereka yang tidak mengalami hipertensi gestasional. 1,7 Sekitar sepertiga (35,29%) wanita yang mengalami ICH juga mengalami eklampsia atau preeklampsia, dengan risiko ICH 9,23 kali lebih tinggi dibandingkan mereka yang tidak eklampsia atau preeklampsia. Meskipun tatalaksana definitif eklampsia dan preeklampsia adalah persalinan, namun pada beberapa kondisi tertentu, persalinan dapat ditunda untuk mencapai target janin yang lebih matur; bahkan setelah melahirkan, angka kejadian preeklampsia dapat meningkat, sehingga, sangat penting untuk mengobati hipertensi berat agar dapat mencegah terjadinya ICH.…”

Section: Epidemiologi Strok Maternalunclassified

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Managemen Anestesi untuk Seksio Sesarea dengan Strok Maternal Hemoragik

Bisri¹,

Lalenoh²

2023

JNI

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Stroke is the third leading cause of morbidity and mortality in many developed countries. Cerebrovascular disease during pregnancy can result from three main mechanisms—bleeding, arterial infarction, and venous thrombosis. Maternal stroke can be either ischemic or hemorrhagic. Ischemic stroke is a common stroke caused by loss of blood supply to an area of the brain. Hemorrhagic stroke is caused by bleeding into the brain due to rupture of a blood vessel. Cesarean section or neurosurgical intervention should be prioritized or performed simultaneously is an important issue, as is the decision to use general anesthesia or spinal and epidural when a cesarean section is performed. The anesthesia technique used should be made taking into account the overall maternal risk. Hyperventilation to reduce intracranial pressure (ICP) should be kept in the range of 25-30 mmHg because the normal range of PaCO2 during pregnancy decreases to 30-32 mmHg due to increased ventilation and progesterone. The use of mannitol to control ICP, there are associated risks of fetal dehydration; While other reports show that 0.2 to 0.5mg/kg of mannitol has no significant effect on fetal fluid balance. Special consideration is needed for women with preeclampsia. General anesthesia for cesarean section is associated with an increased risk of stroke when compared to neuraxial anesthesia in preeclampsic women. Regardless of maternal preeclampic status, maintenance of adequate oxygenation and hemodynamic stability is important for maternal and fetal safety.

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“…In the first case, general anesthesia is indicated for surgical delivery, even if some precautions on drugs choice, especially inhalation agents, should be taken into consideration. This strategy prevents the fetus from exposure to some treatments employed during neurosurgery, such as hyperventilation, mannitol, barbiturates and opioids and at the same time makes the mother more manageable ( 73 , 74 ).…”

Section: Introductionmentioning

confidence: 99%

Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint

et al. 2022

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Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.

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Neuro-anesthesiology in pregnancy

Cited by 8 publications

References 80 publications

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

Managemen Anestesi untuk Seksio Sesarea dengan Strok Maternal Hemoragik

Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint

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