Kuhnigk H, Danhauser-Leistner I
Institut für Anästhesiologie, Universität Würzburg.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1994 May;29(3):184-7. doi: 10.1055/s-2007-996715.
We report on a 31-year old pregnant patient with von-Hippel-Lindau syndrome who presented to the emergency room with symptoms of increased intracranial pressure. She was found in premature labour with a normal foetus of 29 weeks' gestational age in breech presentation. We discuss an anaesthetic and neurosurgical management during emergent craniotomy and Caesarean section. Caesarean section and posterior fossa craniotomy with resection of an angioblastoma are performed in one setting. Following rapid sequence induction with thiopentone and succinylcholine, anaesthesia is maintained with fentanyl, flunitrazepam and pancuronium; nitrous oxide and volatile anaesthetics are avoided. The advantages of this technique include haemodynamic stability and maintenance of intracranial pressure. Neonatal depression is likely with this technique and requires resuscitative measures. The indications for rapid sequence induction in pregnant patients with raised intracranial pressure at risk for aspiration are discussed. Different options for monitoring during this procedure are described.
我们报告了一名31岁患有冯-希佩尔-林道综合征的孕妇，她因颅内压升高症状被送往急诊室。检查发现她处于早产状态，孕周29周的胎儿正常，胎位为臀位。我们讨论了急诊开颅手术和剖宫产期间的麻醉及神经外科处理。在同一台手术中进行了剖宫产及后颅窝开颅切除血管母细胞瘤。采用硫喷妥钠和琥珀酰胆碱进行快速顺序诱导后，用芬太尼、氟硝西泮和泮库溴铵维持麻醉；避免使用氧化亚氮和挥发性麻醉剂。该技术的优点包括血流动力学稳定和颅内压维持。此技术可能导致新生儿抑制，需要采取复苏措施。讨论了对有误吸风险的颅内压升高孕妇进行快速顺序诱导的指征。描述了该手术过程中的不同监测选项。
