Anaesthesia for Neurosurgical Procedures in Pregnant Patients: a Systematic Review

Authors: Lauretta MP, Lubin A, Fomberstein KM, Bosellino B, Spennati V, Bilotta F.

Abstract 


Background: Several neurological diseases manifest predominantly in pregnancy. These are usually associated with pregnancy-related conditions: vascular endothelial dysfunction and activation of hormonal receptors on cells surfaces. The aim of this systematic review is to report recent (in the last 10 years) clinical evidence related to anesthetic management of pregnant women undergoing neurosurgery.
Methods: Two medical databases, PubMed and Embase, were queried in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement recommendations. Key words used for the literature search were: “neuroanesthesia & pregnancy”, “intracranial procedures & pregnancy, “brain tumor & pregnancy”, “neurosurgery & pregnancy”, “neuroradiology & pregnancy”, “neuroprotection in pregnancy” and “traumatic brain injury & pregnancy”. Complete studies published in peer-reviewed journals between January 2005 and October 2015 were considered to be eligible; abstracts were excluded. The search criteria for inclusion in this review were limited to the following: language (English); study type (human, clinical article, clinical trial, controlled clinical trial, controlled study, randomized controlled trials, case reports). 
Results: A total of 567 articles were retrieved using the listed keywords; 77 were selected and categorized into 3 groups: (1) Brain tumors in pregnancy & anesthetic management; (2) Cerebral vascular lesions in pregnancy (acute subarachnoid hemorrhage in pregnancy and stroke in pregnancy) & anesthetic management; (3) Traumatic brain injury in pregnancy & anesthetic management.
Conclusion: Anesthetic management involves a multidisciplinary team to ensure the best outcome of the mother and fetus. General anesthesia (GA) seems to be the safest type of anesthesia to administer during neurological procedures in pregnant patients. Cardiotography (CTG) monitoring seems less useful, as a silent CTG is a normal consequence of general anesthesia. Fetal heart rate monitoring is more accurate, can be performed easily during neurological procedures in pregnant patients; it is sensitive marker to obtain significant information about fetal condition during GA.

Anaesthesia for neurosurgical procedures in pregnant patients: a systematic review