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Anesthesia For Cesarean Delivery In A Patient With An Intramedullary Glioblastoma

Raquel Laranja Pontes

出版	Morressier, 2017
URL	http://books.google.com.hk/books?id=cz56zgEACAAJ&hl=&source=gbs_api

註釋

Introduction:Primary spinal glioblastoma(GBM)is rare and has a poor prognosis. There are reports of pregnant patients with malignant central nervous system tumors who require an early delivery of the fetus before definite therapy can be administered to the mother. To our knowledge neither the association of GBM with pregnancy nor the anesthetic management of pregnant woman with GBM purposed for C-section have been previously described. Case Report:A 33-year-old female,G2P1,diagnosed at 20-week gestation with an intramedullary glioblastoma grade IV extending from C6 to T3, was admitted for elective cesarean delivery at 29-week gestation.The patient medical history was otherwise unremarkable. Surgical history included a decompressive laminectomy and partial removal of the tumor at 23-week gestation. Preoperative assessment revealed an AIS D tetraparesis (motor level by C5/C6 and sensitive level by C7). There was also a significant limitation of neck mobility. Laboratory studies showed an anemia. General anesthesia was performed.Monitoring included pulse oximetry, invasive blood pressure, 5-lead electrocardiogram, depth of anesthesia, neuromuscular block and urine output. RSI was realized with bolus doses of propofol and rocuronium. Tracheal intubation with videolaryngoscopy was successfully attained.Anesthesia was maintained with nitrous oxide and sevoflurane and supplemented with fentanyl after baby delivery.The male infant had Apgar scores of 5/7/8 at 1/5/10 min. Neuromuscular block was reversed using sugamadex and the patient was extubated and carried to the intensive care unit without incident.The mother was discharged after 19 days with a similar neurologic condition.Discussion:C-section under neuraxial anesthesia remains the mainstay of management in parturients. However, a pre-existing neurologic disorder is a risk factor for neurologic complications associated with regional anesthesia. In fact, most authors consider that a spinal cord tumor is a contraindication to regional anesthesia.Also, parturients who have had recent surgery on their vertebral column/neuraxis may be unwilling to have neuraxial anesthesia.We considered that general anesthesia was the best option in our case.Given the increased risk of aspiration RSI was performed.A videolaryngoscope was used for intubation to minimize neck mobilization.Learning Points: We report for the first time the use of general anesthesia as a successful anesthetic technique for pregnant women with GBM.