Goal oriented general anesthesia for Cesarean section in a parturient witha large intracranial epidermoid cyst

Citation
C. Imarengiaye et al., Goal oriented general anesthesia for Cesarean section in a parturient witha large intracranial epidermoid cyst, CAN J ANAES, 48(9), 2001, pp. 884-889
Citations number
25
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
ISSN journal
0832-610X → ACNP
Volume
48
Issue
9
Year of publication
2001
Pages
884 - 889
Database
ISI
SICI code
0832-610X(200110)48:9<884:GOGAFC>2.0.ZU;2-K
Abstract
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.