Abstract
Subarachnoid hemorrhage due to rupture of cerebral aneurysm during pregnancy is a rare complication, but, should it occur, the maternal mortality rate is 13-35%. We report anesthetic management in two pregnant women (32 and 33 weeks' gestation) , who underwent Cesarean section and cerebral aneurysm clipping. Anesthesia was induced with thiopental or propofol, vecuronium or suxamethonium, and fentanyl, and maintained with sevoflurane (<1 MAC) before the delivery. Systolic blood pressure was maintained at 100-140 mmHg and mild hypocapnea was elected. Both newborns did well despite requiring artificial ventilation and surfactant therapy for two days. After the delivery, anesthesia was maintained with fentanyl, remifentanil for aneurysm clipping, and oxytocin to prevent uterine bleeding. Postoperative courses of both mothers and fetuses were uneventful. Careful anesthetic consideration for maintaining uterine circulation and avoiding rupture of aneurysm is essential to obtaining satisfactory outcome of both mother and fetus.
