![]() Routine monitoring in mild to moderate head injury is not recommended however, case-by-case assessment may be warranted. A computed tomography (CT) scan can be delayed in patients with hypotension owing to abdomen bleeding, and they should undergo emergent laparotomy first after an urgent craniotomy. 10 Early hyperventilation is not desired as it causes cerebral ischemia, so normocarbia should be maintained in the first 24 h and thereafter. 10 Prolonged prophylactic hyperventilation is not recommended. Consider the Cerebral spinal fluid (CSF) drainage method to decrease Intracranial pressure (ICP) in severe TBI with Glasgow Coma Scale (GCS) 6 during the first 12 h after injury. Intracranial pressure to be kept <20 mmgg and managed with osmotic diuretics such as hypertonic saline, mannitol (0.25–1 g/kg), and raising the head end of the bed by 15 °–20 °. 10 Systolic blood pressure <90 mm Hg should be aggressively managed, and cerebral perfusion pressure to be targeted between 50 and 70 mmHg. A single episode of hypotension is associated with a worse outcome in this subset of patients in comparison with patients who never had hypotension. A caesarean section may be performed to improve maternal hemodynamics. The indications of performing neurosurgery or opting for conservative management after TBI are the same as in non-pregnant patients. ![]() The early and aggressive protocol-based resuscitation is the cornerstone of management after traumatic brain injury (TBI). Gravid uterus tends to protect from gastrointestinal injuries, but increased tissue vascularity aggravates splenic and retroperitoneal hemorrhage. Transportation accidents, falls, physical attack, and burn injuries are the familiar etiologies. ![]() 9 Incidence of trauma during pregnancy is 8%, 40%, and 52% in the first, second, and third trimester, respectively. 6 If untreated, an AVM in the pregnant woman may pose a threat to the mother and the fetus.Īpproximately, trauma complicates one in every 12 pregnancies and is the principal cause of non-obstetric maternal death and may involve spinal or cranial injury. An elevated cardiac output and hormonal effects have been involved in the possibility of rupture of AVMs in the last trimester. 5 The possibility of repetitive bleeding during the rest of pregnancy in patients with an untreated aneurysm is as high as 33%–50% and contributes 50%–68% maternal death.ĪVMs are responsible for about 50% of SAH in pregnant women. 4 There is no difference of management in pregnant patients over aSAH patients. The risk of rupture of an aneurysm increases with each trimester, with the greatest risk around the time of child birth.Īneurysmal subarachnoid hemorrhage (aSAH) during pregnancy is the third most common cause of maternal death from non-obstetric cause with an incidence of 0.01%–0.05%. The risk of bleeding is higher during pregnancy because of the increased intravascular volume and cardiac output along with the effects of hormones on the vessel wall. 3 Hypertensive bleed, vasculitis, and traumatic bleed are other possible causes. SAH may be up to five times common during pregnancy compared with non-pregnant states. The following neurological conditions would merit special consideration during pregnancy.īleeding due to arteriovenous malformation (AVM) and intracranial aneurysm are the most common causes of subarachnoid hemorrhage (SAH) during pregnancy. With the lack of guidelines, management is based largely on few case reports or case series. Navigating these uncharted waters remains a challenging exercise. Review of literature revealed paucity of evidence-based neuroanesthesia management for such patients. Malignant brain tumors and trauma remain a leading cause of indirect maternal mortality. The brain is one of the vital organs of the body, and physiological changes during pregnancy alter the anesthesia management if associated with brain pathology. 2 Pregnancy is associated with a host of anatomical and physiological alterations that complicate the conduct of anesthesia. 2 Over the last two decades, the obstetric cause of mortality in the pregnant patient has declined, but the trend is rising for non-obstetric cause of mortality. 1 An incidence of 30–40 deaths per triennium in pregnant patients is reported because of brain pathology. A pregnant lady requiring non-obstetric surgery during pregnancy is rare.
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