Anaesthetic management of giant encephalocele

Kumar, Rajeev; Jain, Shuchi; Mehta, Ranveer Kumar; Trivedi, Swati

doi:10.18203/2320-6012.ijrms20151464

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Further, a huge occipital encephalocele will also hamper the head extension required for laryngoscopy. Placing the child's head on the edge of the table with an assistant supporting the sac has also been used to achieve an optimal position for airway handling [ 9 , 10 ]. This technique involves the presence of an assistant at the head end of the table, which may create a space constraint.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Giant Occipital Encephalocele With Thoracic Myelomeningocele: An Anesthetic Conundrum

Kalbande¹,

Deotale²,

Singha³

et al. 2022

Cureus

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Encephalocele and myelomeningocele are congenital defects in the cranium and spine with herniation of contents into an extracranial and extraspinal sac, respectively. The occurrence of encephalocele and myelomeningocele in the same patient has rarely been described in the literature. The anesthetic management of such cases is associated with multiple challenges, which include difficulty in securing the airway, prone positioning, blood loss, electrolyte imbalance, hypothermia, cardiorespiratory disturbances, and perioperative care. The main aims are, to prevent hemodynamic fluctuations and excessive pressure on the sac to avoid premature rupture and manage a possible difficult airway due to the head and neck mass. We report such a rare case to highlight and share our experiences faced during perioperative management of a giant vascular occipital encephalocele with impending rupture and thoracic myelomeningocele requiring surgical excision and repair. Previous similar case reports were also reviewed, and potential perioperative complications were discussed.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of Giant Occipital Encephalocele With Thoracic Myelomeningocele: An Anesthetic Conundrum

Kalbande¹,

Deotale²,

Singha³

et al. 2022

Cureus

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“…Main aims should be to avoid premature rupture of the meningocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for endotracheal intubation. [4] Airway management of neonates and pediatric population is difficult compared with adult due to anatomic variations such as short neck, large tongue and large head. Also paediatric patients have low functional reserve volume and failure to intubate may result in hypoxaemia, bradycardia and even cardiac arrest.Difficult airway cart with ventilation masks, tracheal tubes, airways, scope blades etc., should be kept ready.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of a Giant Cervico-Occipital Meningocele with Cleft Palate

Jain

Dalal²,

Bamba

2020

AAN

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Meningocele is herniation of meninges and CSF through the skull and vertebral defect. The major anaesthetic challenges encountered in management of cervico-occipital meningocele include difficulty in securing airway, proper positioning of the neonate without pressure on the meningocoele sac, maintaining prone position and prevention of electrolyte disturbances and hypothermia. Associated congenital anomalies also can cause anaesthesia and procedure related complications. We report a case of 25 day old neonate with giant cervico occipital meningocele with cleft palate posted for excision and repair.

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“…Giant occipital encephalocele hampers the head extension as well as neutral supine positioning of the head in a suitable way for DL. To overcome these problems anesthesiologists have attempted DL by keeping the child in lateral position, or placing the child's head beyond the edge of the table with manual supports from assistants [1,4,5]. The modifications like supporting the swelling with a doughnut, gel or cotton bolsters, folded surgical drapes etc.…”

Section: Discussionmentioning

confidence: 99%

Adjustable Horseshoe Headrest as a Positioning Adjunct in Airway Management for a Giant Occipital Encephalocele

Karim¹,

Yunus²,

Barman³

et al. 2017

TOATJ

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Background: Presence of a giant occipital encephalocele poses a challenge for laryngoscopy by hindering optimal positioning. Intubations in different positions, assistance and modification of table surfaces have been reported with different rates of success and complications in such cases. Method: We used an adjustable horseshoe headrest as a positioning adjunct in airway management in a few cases during 2015 – 2016. Four babies were positioned with the help of the horseshoe headrest for direct laryngoscopy. These cases were then compared with previously conducted one more case whose trachea was intubated by the child’s head beyond the edge after an unsuccessful attempt in lateral position. Result: All four cases positioned with adjustable horseshoe head rest were intubated successfully with mean 2 ± 0.81 attempts with 2.25 ± 0.5 Cormack-Lehane laryngeal view. Significant complications were absent in the cases intubated by placing the head in horseshoe headrest as compared to the case performed in lateral position followed by placing the child’s head beyond the edge of the table with assistants supporting the baby. Conclusion: This clinical paper discusses this infrequently reported modification, and also compares it with other positions and modifications commonly used in clinical practice.

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Anaesthetic management of giant encephalocele

Cited by 3 publications

References 14 publications

A Rare Case of Giant Occipital Encephalocele With Thoracic Myelomeningocele: An Anesthetic Conundrum

A Rare Case of Giant Occipital Encephalocele With Thoracic Myelomeningocele: An Anesthetic Conundrum

Anaesthetic Management of a Giant Cervico-Occipital Meningocele with Cleft Palate

Adjustable Horseshoe Headrest as a Positioning Adjunct in Airway Management for a Giant Occipital Encephalocele

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