Abstract
Purpose
To describe the anesthetic management of a parturient with a large acoustic neuroma undergoing general anesthesia with remifentanil for Cesarean section.
Clinical features
A near-term parturient presented with a large intracranial mass. Cesarean section under general anesthesia was elected one week prior to craniotomy for tumour resection. Remifentanil infusion, 0.2–1.0 μg · kg−1 · min−1, was used from induction to emergence of general anesthesia. The neonate was born seven minutes after the remifentanil infusion was started. She had normal umbilical cord pH and her Apgar scores were 7 and 8, at one and five minutes respectively. Although the neonate received supplemental oxygen, she did not require naloxone. Both mother and neonate made an uneventful recovery.
Conclusion
Remifentanil was effective in producing stable hemodynamic conditions, without severe neonatal respiratory depression, during induction and maintenance of general anesthesia for a Cesarean delivery in a parturient with a large intracranial tumour.
Abstract
Objectif
Décrire la conduite de l’anesthésie générale avec le rémifentanil pour une césarienne chez une patiente enceinte ayant un neurinome acoustique.
Aspects cliniques
Une femme enceinte s’est présentée avec une volumineuse masse intracrânienne quelques semaines avant terme. Une césarienne sous anesthésie générale a été planifiée une semaine avant de procéder à la résection de la tumeur intracrânienne. Le rémifentanil en perfusion intraveineuse a été utilisé de l’induction à l’émergence, à des doses variant de 0.2–1.0 μg · kg−1 · min−1. L’enfant est né après sept minutes de perfusion de rémifentanil. Les gaz du cordon étaient normaux et les Apgar à une et cinq minutes étaient respectivement 7 et 8. Malgré l’apport temporaire d’oxygène, le nouveau-né n’a pas eu besoin de naloxone. La mère et l’enfant ont eu une convalescence sans complication.
Conclusion
Le rémifentanil a permis des conditions hémodynamiques stables, sans produire de dépression respiratoire significative chez le nouveau-né, pendant l’induction et la maintenance de l’anesthésie générale pour une césarienne chez une patiente avec une volumineuse tumeur intracrânienne.
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Bédard, J.M., Richardson, M.G. & Wissler, R.N. General anesthesia with remifentanil for Cesarean section in a parturient with an acoustic neuroma. Can J Anesth 46, 576–580 (1999). https://doi.org/10.1007/BF03013550
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DOI: https://doi.org/10.1007/BF03013550