Controlled Hypotension for Cerebral Aneurysm Surgery in Pregnancy / 대한마취과학회지

ABSTRACT

A pregnant patient at 32 weeks gestation presented for cerebral aneurysm surgery. Int-ravenous lidocane, pancuronium was administrated with 4% lidocane spray to facilitate tracheal intubation. Anesthesia was induced with thiopental and maintained with oxygen-nitrous oxide-enflurane. Thalamonal was also used to reduce blood pressure after tracheal intubation. Monitoring included an arterial catheter for measuring blood pressure and arterial blood gas tension, an electrocardiogram, an esophageal temperature probe, end-tidal carbon-dioxide monitor and a Dopp1er ultrasound fetal heart monitor. Induced bypotension guided by fetal heat rate with high-dose enflurane and hyperventi-lation was employed to facilitate aneurysm coating. During coating of the aneurysm, mean arterial blood pressure was reduced to 67 mmHg and maintained for 10 minutes. Throughout the anesthesia, the fetal heart rate remained between 110 and 144 beats/min. Following completion of anesthesia, the patient emerged from anesthesia and about 5 hours postoperatively premature labor could be seen with an external tocodynamometer, that was relieved by intramuscular injection of pethidine, 50 mg, Postoperatively the patient was discharged from hospital with a rapid and uneventful recovery at fifteenth day of operation. The mother was readmitted for elective cesarean section at 38 weeks of pregnancy and spinal anesthesia was performed. A healthy 2.9kg infant was delivered and they were uneventfully discharged. We report successful management of anesthesia in a pregnant patient undergoing aneurysm surgery during enflorane-induced hypotension with appropriate maternal and fetal monitoring.