Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2023 Feb 3;102(5):e32753. doi: 10.1097/MD.0000000000032753.
There is no clear consensus guidance for anesthesiologists on how to manage patients with cerebral arteriovenous malformation (cAVM) rupture and hemorrhage during pregnancy who need craniotomy. Our objective was to review the anesthesia management of pregnant women who underwent resection of cAVM at our institution and to provide opinions and suggestions.
Herein, we report of 3 patients with cAVM rupture and hemorrhage during pregnancy who underwent neurosurgery at the 22nd, 28th, and 20th weeks of pregnancy.
All 3 patients were admitted to the emergency department of our hospital due to sudden symptoms. Subsequently, their head imaging results confirmed the rupture and hemorrhage of cAVM. The rupture and hemorrhage of cAVM during pregnancy has a low incidence and high mortality, which seriously endangers the safety of the mother and fetus. For this emergency condition, craniotomy for removing intracranial lesions and clear hematoma can result in a chance of a successful delivery. Especially in the second and third trimesters of pregnancy, the management goal of anesthesia is to ensure the maternofetal safety and to maintain continuous pregnancy.
This article describes the process of intraoperative anesthesia management and maternal-fetal outcomes and discusses the key issues for the anesthesia management of cAVM rupture during pregnancy, including considerations of physiological changes during pregnancy and anesthesia medication, intraoperative monitoring, the maintenance of hemodynamic stability, and the control of intracranial pressure, among other considerations. Resection of intracranial lesions should be performed whenever possible while maintaining the pregnancy for better maternal and infant outcomes.
The operations of the 3 pregnant women were successfully completed under our detailed anesthesia planning and careful anesthesia management. All the patients recovered well after the operation, and underwent cesarean section to give birth smoothly.
The preservation of pregnancy under cAVM resection is a complex challenge for anesthesiologists, and these 3 cases provide an extensive amount of experience for anesthesia management in similar situations. Detailed anesthesia planning and careful anesthesia management by anesthesiologists are important guarantees for good maternal and fetal outcomes.
对于需要开颅手术的脑动静脉畸形（cAVM）破裂出血孕妇，麻醉医生在管理上没有明确的共识指南。我们的目的是回顾本机构行 cAVM 切除术孕妇的麻醉管理经验，并提供意见和建议。
本研究报道了 3 例妊娠期间 cAVM 破裂出血孕妇，分别在妊娠 22 周、28 周和 20 周接受神经外科手术。所有患者均因突然症状而被收入我院急诊。随后，头部影像学结果证实 cAVM 破裂出血。妊娠期间 cAVM 破裂出血发病率低但死亡率高，严重威胁母婴安全。对于这种紧急情况，开颅清除颅内病灶和清除血肿可增加成功分娩的机会。特别是在妊娠 2 至 3 个月期间，麻醉管理的目标是确保母婴安全并维持妊娠继续。
本文描述了术中麻醉管理过程和母婴结局，并讨论了妊娠期间 cAVM 破裂麻醉管理的关键问题，包括考虑妊娠期间的生理变化和麻醉药物、术中监测、维持血流动力学稳定、控制颅内压等。应尽可能切除颅内病灶，同时保持妊娠以获得更好的母婴结局。
这 3 例孕妇的手术均在我们详细的麻醉计划和精心的麻醉管理下成功完成。所有患者术后恢复良好，并顺利行剖宫产术分娩。
cAVM 切除术中保留妊娠对麻醉医生是一个复杂的挑战，这 3 例病例为类似情况下的麻醉管理提供了丰富的经验。麻醉医生详细的麻醉计划和精心的麻醉管理是母婴结局良好的重要保证。
