Nishiyama T, Nagase M, Tamai H, Watanabe S, Hirasaki A
Department of Anesthesiology, JR Tokyo General Hospital.
Masui. 1994 Sep;43(9):1341-4.
A 29 year old woman suffered sudden hemiplegia, vomiting and headache during the 28th week of her first pregnancy. She was diagnosed as the intracranial hemorrhage due to the ruptured arteriovenous malformation, and emergency operation was performed. Anesthesia was induced with crush induction using thiamylal, fentanyl, pancuronium and suxamethonium, and maintained with fentanyl, isoflurane and nitrous oxide in oxygen. During and after surgery, fetal heart rate and uterine contraction were monitored continuously. Intense hypotension was not chosen because it may place a fetus at risk of intrauterine asphyxia. Ventilation was controlled to maintain PaCO2 between 30 and 35 mmHg. During surgery, D-mannitol 60 g was infused slowly to prevent fetal dehydration, and after surgery no osmotic diuretics were used. Ritodrine hydrochloride, which prevented premature delivery, was continuously infused after surgery. Her neurological symptom was improved and her baby was delivered vaginally at 41st gestational week.
一名29岁女性在首次怀孕第28周时突然出现偏瘫、呕吐和头痛。她被诊断为因动静脉畸形破裂导致颅内出血，并接受了急诊手术。麻醉诱导采用硫喷妥钠、芬太尼、潘库溴铵和琥珀胆碱进行快速诱导，并以芬太尼、异氟烷和氧化亚氮-氧气维持。手术期间及术后持续监测胎儿心率和子宫收缩情况。未选择剧烈低血压，因为这可能使胎儿面临宫内窒息风险。控制通气以维持动脉血二氧化碳分压在30至35 mmHg之间。手术期间缓慢输注60 g D-甘露醇以防止胎儿脱水，术后未使用渗透性利尿剂。术后持续输注盐酸利托君以防止早产。她的神经症状得到改善，婴儿在孕41周时经阴道分娩。
