Purpose: To illustrate the anesthetic management of a term parturient with
a large brain tumour scheduled for Cesarean section.
Clinical features: A 26-yr-old woman presented at 33 weeks gestation with a
generalized grand mal seizure. Magnetic resonance imaging demonstrated a 5
-cm multi-lobulated extra axial mass compatible with an epidermoid cyst, ar
ising from the left temporal lobe associated with shift of the midline stru
ctures and compression of the brainstem. She remained stable neurologically
until elective Cesarean section at 38 weeks. Immediately prior to inductio
n of general anesthesia, the proposed incision site was infiltrated with li
docaine and the supraglottic structures anesthetized with bilateral superio
r laryngeal nerve blocks. Remifentanil, thiopentone sodium and succinylchol
ine were administered in a rapid sequence fashion following voluntary hyper
ventilation to an endtidal CO2 of 28 mmHg. Anesthesia was maintained with d
esflurane in oxygen/air and an infusion of remifentanil. Postoperative pain
control was achieved using a multi-modal approach which included intraperi
toneal deposition of local anesthetic, inn ketorolac and rectal acetaminoph
en prior to emergence followed by regular administration of naproxen and ac
etaminophen for 72 hr.
Conclusion: In a parturient with a large intracranial tumour, general anest
hesia combined with multi-modal balanced analgesia met the predefined anest
hetic management goals and was associated with a favourable outcome.