Maissin F, Mesz M, Roualdès G, Bataille B, Criscuolo J L
Département d'Anesthésie-Réanimation, Hôpital Jean-Bernard, Poitiers.
Ann Fr Anesth Reanim. 1987;6(5):453-6. doi: 10.1016/s0750-7658(87)80372-6.
A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.
一名31岁初产妇在妊娠31周时因蛛网膜下腔出血入院。脑血管造影显示左大脑中动脉有一个动脉瘤。11天后，动脉瘤被夹闭。采用硫喷妥钠、泮库溴铵和芬太尼诱导全身麻醉，并用芬太尼（40微克·千克-1）和异氟烷在空气/氧气中通过无重复吸入回路维持麻醉。患者进行机械通气以维持轻度低碳酸血症。通过将吸入异氟烷浓度从1%提高到3%来诱导动脉低血压。反应迅速，吸入异氟烷浓度为2.5%时平均动脉压维持在60 mmHg达80分钟。在全身麻醉前、期间和之后监测胎儿心率。诱导后观察到逐搏变异消失，手术结束时胎儿心率从150次/分钟缓慢降至115次/分钟。术后情况良好，只是有短暂性失语。妊娠35周时，患者早产，体温39.5摄氏度；进行了急诊剖宫产。这名体重2340克的女婴阿氏评分10分钟为8分。一个月后，对母婴的临床检查相当正常。本文回顾了妊娠末期患有破裂脑动脉瘤患者的预防措施和麻醉管理。并对降压药物进行了讨论。
