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Neuroanesthesia and Pregnancy

  • Valentina Della Torre
  • Alessandro Bertuccio
  • Chiara Robba
Chapter

Abstract

Several neurological diseases manifest predominantly in pregnancy. These are usually associated with pregnancy-related conditions: vascular endothelial dysfunction and activation of hormonal receptors on cell surfaces.

Anesthetic management involves a multidisciplinary team to ensure the best outcome of the mother and fetus. General anesthesia (GA) seems to be the safest type of anesthesia to administer during neurological procedures in pregnant patients. Cardiotocography (CTG) monitoring seems less useful, as a silent CTG is a normal consequence of general anesthesia. Fetal heart rate monitoring is more accurate and can be performed easily during neurological procedures in pregnant patients; it is a sensitive marker to obtain significant information about fetal condition during GA. The aim of this chapter is to report recent clinical evidence related to anesthetic management of pregnant women undergoing neurosurgery.

Keywords

Neuroanesthesia and pregnancy Intracranial procedures and pregnancy Brain tumors and pregnancy Neurosurgery and pregnancy Traumatic brain injury and pregnancy 

References

  1. 1.
    Block HS, Biller J. Neurology of pregnancy. Handbook of clinical neurology, vol. 121. Amsterdam: Elsevier; 2014. p. 1595–624.Google Scholar
  2. 2.
    Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg. 2008;107:193–200.CrossRefGoogle Scholar
  3. 3.
    Qaiser R, Black P. Neurosurgery in pregnancy. Semin Neurol. 2007;27:476–81.CrossRefGoogle Scholar
  4. 4.
    Muench MV, Canterino JC. Trauma in pregnancy. Obstet Gynecol Clin North Am. 2007;34:476–81.CrossRefGoogle Scholar
  5. 5.
    Lynch JC, Gouvea F, Emmerich JC, et al. Management strategy for brain tumour diagnosed during pregnancy. Br J Neurosurg. 2011;25:225–30.CrossRefGoogle Scholar
  6. 6.
    Bateman BT, Schumacher HC, Bushnell CD, et al. Intracerebral haemorrhage in pregnancy: frequency, risk factors and outcome. Neurology. 2006;67:424–9.CrossRefGoogle Scholar
  7. 7.
    Elwatidy S, Jamjoom Z, Elgamal E, et al. Management strategies for acute brain lesions presenting during pregnancy: a case series. Br J Neurosurg. 2011;25:478–87.CrossRefGoogle Scholar
  8. 8.
    Cohen-Gadol AA, Friedman JA, et al. Neurosurgical management of intracranial lesions in the pregnant patient: a 36 year institutional experience and review of the literature. J Neurosurg. 2009;111:1150–7.CrossRefGoogle Scholar
  9. 9.
    Johnson AC, Cipolla MJ. The cerebral circulation during pregnancy: adapting to preserve normality. Physiology. 2015;30:139–54.CrossRefGoogle Scholar
  10. 10.
    Khan M, Wasay M, Menon B, et al. Pregnancy and puerperium related strokes in Asian women. J Stroke Cerebrovasc Dis. 2013;22:1393–8.CrossRefGoogle Scholar
  11. 11.
    Robinson JL, Hall CS, Sedzimir CB. Arteriovenous malformations, aneurysms, and pregnancy. J Neurosurg. 2011;41:63–70.CrossRefGoogle Scholar
  12. 12.
    Hassan A, El Moumani AW. Pregnancy and ventriculoperitoneal shunt: report of a case and literature review. Acta Obstet Gynecol Scand. 2009;67:669–70.CrossRefGoogle Scholar
  13. 13.
    Wicassono Santi B, Sulistyono A, Dachlan EG. Brain injury on pregnancy. Pregnan Hypertens. 2011;1:295–6.CrossRefGoogle Scholar
  14. 14.
    Hopkins AN, Alshaeri T, Akst SA, et al. Neurologic disease with pregnancy and considerations for the obstetric anesthesiologist. Semin Perinatol. 2014;38:359–69.CrossRefGoogle Scholar
  15. 15.
    Neurosurgery and the parturient. Anesthesia tutorial of the week 253. London: World Federation of Societies of Anaesthesiologists; 2012.Google Scholar
  16. 16.
    Cook T, Woodall N, Frerk C. 4th National Audit of the Royal College of Anaesthetists and the Difficult Airway Society: Major Complications of airway management in the United Kingdom. London: Royal College of Anaesthetists and the Difficult Airway Society; 2012.Google Scholar
  17. 17.
    Bacigaluppi S, Piccinelli M, Antiga L, et al. Factors affecting formation and rupture of intracranial saccular aneurysms. Neurosurg Rev. 2014;37:1–14.CrossRefGoogle Scholar
  18. 18.
    Hop JW, Rinkel GJ, Algra A, et al. Case-fatality rates and functional outcome after sub-arachnoid haemorrhage: a systematic review. Stroke. 1997;28:660–4.CrossRefGoogle Scholar
  19. 19.
    Nelson PB, Robinson AG, Archer DF, et al. Symptomatic pituitary tumor enlargement after induced pregnancy. Case report. J Neurosurg. 2006;49:283–7.CrossRefGoogle Scholar
  20. 20.
    Wisoff JH, Kratzert KJ, Handwerker SM, et al. Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature. Neurosurgery. 2001;29:827–31.CrossRefGoogle Scholar
  21. 21.
    Clapp JF, Capeless E. Cardiovascular function before, during and after the first and subsequent pregnancies. Am J Cardiol. 1997;111:1150–7.Google Scholar
  22. 22.
    Ostrom QT, Gittleman H, Farah P, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006-2010. Neuro Oncol. 2013;15(Suppl 2):ii1.CrossRefGoogle Scholar
  23. 23.
    Verheecke M, Halska MJ, Lok CA, et al. Primary brain tumors, meningiomas and brain metastases in pregnancy: report on 27 cases and review of the literature. Eur J Cancer. 2014;50:1462–71.CrossRefGoogle Scholar
  24. 24.
    Kasper EM, Hess PE, Silasi M, et al. A obtain management guidelines for intracranial meningiomas during pregnancy. Surg Neurol Int. 2010;1:95.CrossRefGoogle Scholar
  25. 25.
    Kasper EM, Hess PE, Silasi M, et al. A pregnant female with a large intracranial mass: reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy. Surg Neurol Int. 2010;25:1–95.Google Scholar
  26. 26.
    Kanaan I, Jallu A, Kanaan H. Management strategy for meningioma in pregnancy: a clinical study. Skull Base. 2003;13:197–203.CrossRefGoogle Scholar
  27. 27.
    Abd-Elsayed AA, Diaz Gomez J, Barnett GH, et al. A case series discussing the anesthetic management of pregnant patients with brain tumors. Version 2. F1000Res. 2013;2:92.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Tewari KS, Cappuccini F, Astrat T, et al. Obstetric emergencies precipitated by malignant brain tumors. Am J Obstet Gynecol. 2000;182:1215–21.CrossRefGoogle Scholar
  29. 29.
    Calthorpe N, Lewis M. Acid aspiration prophylaxis in labour: a survey of UK obstetric units. Int J Obstet Anesth. 2005;14:300–4.CrossRefGoogle Scholar
  30. 30.
    Garbis H, Elefant E, Diav-Citrin O, et al. Pregnancy outcome after exposure to ranitidine and other H2-blockers. A collaborative study of the European Network of Teratology Information service. Reprod Toxicol. 2005;19:453–8.CrossRefGoogle Scholar
  31. 31.
    Thind AS, Turner RJ. In vitro effects of propofol on gravid human myometrium. Anesth Intens Care. 2008;36:802–6.Google Scholar
  32. 32.
    Jevtovic-Todorovic V. General anesthetics and the developing brain: friends or foes? J Neurosurg Anesthesiol. 2005;17:204–6.CrossRefGoogle Scholar
  33. 33.
    Robba C, Bacigaluppi S, Bragazzi NL, et al. Aneurysmal Subarachnoid Haemorrhage in pregnancy-case series, review and pooled data analysis. World Neurosurg. 2015;24:S1878–8750.Google Scholar
  34. 34.
    James AH, Bushnell CD, Jamison MG, et al. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol. 2005;106:509–16.CrossRefGoogle Scholar
  35. 35.
    Schutte JM, Schuitemaker NW, van Roosmalen J, et al. Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands. Dutch Maternal Mortality Committee. BJOG. 2008;115:732–6.CrossRefGoogle Scholar
  36. 36.
    Huang CY, Chen CA, Hsieh CY, et al. Intracerebral haemorrhage as initial presentation of gestational choriocarcinoma: a case report and literature review. Int J Gynecol Cancer. 2007;17:1166–71.CrossRefGoogle Scholar
  37. 37.
    Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke. 2000;31:1274–82.CrossRefGoogle Scholar
  38. 38.
    Marshman LA, Aspoas AR, Rai MS, et al. The implications of ISAT and ISUIA for the management of cerebral aneurysms during pregnancy. Neurosurg Rev. 2007;30:177–80.CrossRefGoogle Scholar
  39. 39.
    Carvalho CS, Resende F, Centeno MJ, et al. Anesthetic approach of pregnant woman with cerebral arteriovenous malformation and subarachnoid haemorrhage during pregnancy:case report. Anesthesiology. 2013;63:223–6.Google Scholar
  40. 40.
    Coskun D, Mahli A, Yilmaz Z, et al. Anesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report. Cases J. 2008;1:327–9.CrossRefGoogle Scholar
  41. 41.
    Wong C. Spinal and epidural anesthesia. 1st ed. Chicago, IL: McGraw Hill; 2007. p. 281–304.Google Scholar
  42. 42.
    Roy KK, Baruah J, Kumar S, et al. Caesarian section for suspected fetal distress, continuous fetal heart monitoring and decision to deliver time. Indian J Pediatr. 2008;75:1249–52.CrossRefGoogle Scholar
  43. 43.
    Bullock MR, Chestnut R, Ghajar J, et al. Guidelines for the surgical management of traumatic brain injury. Neurosurgery. 2006;58:51–62.CrossRefGoogle Scholar
  44. 44.
    Anson JA, Vaida S, Giampetro DM, et al. Anesthetic management of labor and delivery in patients with elevated intracranial pressure. Int J Obst Anesth. 2015;24:147–60.CrossRefGoogle Scholar
  45. 45.
    Dyer RA, van Dyk D, Dresner A. The use of uterotonic drugs during caesarean section. Int J Obstet Anesth. 2010;19:313–9.CrossRefGoogle Scholar
  46. 46.
    Ngan Kee WD, Lee A, Khaw KS, et al. A randomized double-blinded comparison of phenylephrine and ephedrine combination given by infusion to maintain blood pressure during spinal anesthesia for caesarean delivery: effect on fetal acid-base status and hemodynamic control. Anesth Analg. 2008;107:1295–302.CrossRefGoogle Scholar
  47. 47.
    Passero S, Rocchi R, Rossi S, et al. Seizures after spontaneous intracerebral haemorrhage. Epilepsia. 2002;43:1175–80.CrossRefGoogle Scholar
  48. 48.
    Peck TE, Hill SA, Williams M. Pharmacology for anaesthesia and intensive care. 3rd ed. Cambridge: Cambridge University Press; 2003.Google Scholar
  49. 49.
    Kilpatrick CC, Puig C, Chohan L, et al. Intraoperative fetal heart monitoring during nonobstetric surgery in pregnancy: a practice survey. South Med J. 2010;103:212–5.CrossRefGoogle Scholar
  50. 50.
    Shaw P, Duncan A, Vouyoika A, et al. Radiation exposure in pregnancy. J Vasc Surg. 2010;53:28S–34S.CrossRefGoogle Scholar
  51. 51.
    Bamber JH, Dresner M. Aortocaval compression in pregnancy: the effect of changing the degree and direction of lateral tilt on maternal cardiac output. Anaesth Analg. 2003;97:256–8.CrossRefGoogle Scholar
  52. 52.
    Stoodley MA, MacDonald RL, Weir BK. Pregnancy and intracranial aneurysms. Neurosurg Clin N Am. 1998;9:855–60.Google Scholar
  53. 53.
    Kittner SJ, Stern BJ, Feeser BR, et al. Pregnancy and the risk of stroke. N Engl J Med. 1996;335:768–74.CrossRefGoogle Scholar
  54. 54.
    Koivisto T, Vanninen R, Hurskainen H, et al. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke. 2000;31:2369–77.CrossRefGoogle Scholar
  55. 55.
    Mosiewicz A, Janusz W, Markiewicz P. Treatment of intracranial aneurysms during pregnancy. Ginekol Pol. 2007;72:86–92.Google Scholar
  56. 56.
    Tuncali B, Aksun M, Katircioglu K. Intraoperative fetal heart monitoring during emergency neurosurgery in a parturient. J Anesth. 2005;20:40–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Valentina Della Torre
    • 1
  • Alessandro Bertuccio
    • 2
  • Chiara Robba
    • 1
  1. 1.Neurocritical Care UnitAddenbrookes HospitalCambridgeUK
  2. 2.Ospedale S Cesare Arrigo Biagio AntonioAlessandriaItaly

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