Anesthesia for cesarean section in two patients with brain tumours

Purpose: To describe two patients with brain tumours where general anesthes ia was used for cesarean sections under emergency and urgent conditions. Clinical features (case #1): The first patient presented at 38 wk gestation with an acute intracranial tumour herniation, requiring emergency cranioto my and simultaneous cesarean section. General anesthesia was induced with t hiopental and vecuronium, maintained with enflurane 1% in O-2 100%. Materna l PETCO2 was maintained at 25 mmHg. After delivering a healthy infant, she was given syntocinon, mannitol and dexamethasone iv; anesthesia was maintai ned with fentanyl, nitrous oxide 50% in O-2 and isoflurane 1% during fronta l-lobe tumour resection. Clinical features (case #2): The second patient presented at 37 wk gestatio n for urgent cesarean section because of placental insufficiency, She had h ad a brain tumour resection four years earlier. An increase in intracranial pressure necessitated craniotomy for decompression at 20 wk gestation, She was further treated with dexamethasone, carbamazepine and radiation for co ntrol of cerebral oedema at 34 wk. Cesarean section was performed under gen eral anesthesia; rapid-sequence- induction with thiopental and succinylchol ine,followed by isoflurane 1% in O-2 100%. Syntocinon, fentanyl and atracur ium iv were administered after delivery of a health infant. Although neuros urgeons stood by, their intervention was unnecessary, Conclusion: General anesthesia remains safe and dependable for operative de livery in parturients with intracranial tumour. Tracheal intubation allows maternal hyperventilation thereby controlling raised intracranial pressure, Hemodynamic stability is readily achieved to maintain cerebral perfusion. However, a multidisciplinary-team approach is critical for successful patie nt management.