Sodium Nitroprusside for Aneurysm Surgery in Pregnancy

Abstract

A 25-year-old woman in the 7th month of pregnancy was operated upon for a ruptured cerebral aneurysm. Sodium nitroprusside was used to achieve effective controlled hypotension. Signs of foetal distress were transient. Subsequent delivery was spontaneous and uneventful. Development of the child at 2 yr was satisfactory. The various physiological aspects and the action of nitroprusside on both mother and foetus are discussed.

Selected Neurologic Complications of Pregnancy

“…[162][163][164][165][166] With controlled hypotension during repair of an intracranial aneurysm in pregnant patients, the risk of transient fetal bradycardia is increased. 73,167,168 Minielly and associates"? found that the fetus tolerated transient controlled hypotension well during such a procedure and that the normal heart rate resumed on termination of hypotension.…”

Does sodium nitroprusside kill babies? A systematic review

“…The search located nine studies, [5][6][7][8][9][10][11][12][13] which are presented in Table 2. The sum of all the publications yielded a total of 22 patients and 24 exposed fetuses (two pairs of twins).…”

Sodium Nitroprusside, Pregnancy and Multiple Intracranial Aneurysms

“…9,10 Primary attention to the mother with judicious use of sodium nitroprusside is unlikely to compromise the foetus. 6,8,11,26 Sodium nitroprusside is not teratogenic in animal experiments. 25 At present, the biochemical consequences for the foetus of prolonged nitrous oxide anaesthesia are not clear.…”

“…5 A more conservative 1 g/kg or less has not proved detrimental. 6,7,8 Currently, controlled hypotension, usually employing sodium nitroprusside (SNP), is the commonest method of facilitating aneurysm clipping. 9, ID In 1979, Minielly et al I reported a series of eight pregnant patients of whom six, in the third trimester, qualified for surgical clipping of their aneurysms.…”