The pregnant patient with an intracranial arteriovenous malformation. Cesarean or vaginal delivery using regional or general anesthesia?

BACKGROUND AND OBJECTIVES

A parturient with large intracranial arteriovenous malformation presented for elective cesarean delivery.

METHODS

The anesthetic technique included acute hydration with intravenous crystalloid followed by continuous epidural anesthesia with bupivacaine and fentanyl and oxygen by face mask. Intraoperative monitoring consisted of electrocardiography, pulse oximetry, invasive arterial blood pressure, and analysis of arterial blood gases. Postoperative analgesia in the immediate postoperative period was provided by a continuous epidural infusion of bupivacaine and fentanyl followed by intravenous patient-controlled analgesia using a mixture of morphine and droperidol.

RESULTS

A cesarean delivery was successfully performed and both mother and infant were eventually discharged from the hospital in good condition.

CONCLUSIONS

In this case report the choice of obstetric management (cesarean versus vaginal delivery) of a full-term parturient with an intracranial arteriovenous malformation is discussed, and the rationale for the preference of epidural anesthesia for the cesarean delivery is presented.