Long-standing meningomyelocele can be a predictor of difficult airway and postoperative hypoventilation: challenge to the anaesthesiologist

Abstract

A 15-year-old female patient presented with severe pain in the abdomen and obstructive uropathy. She underwent Yang-Monti ileovesicostomy under general anaesthesia. She is a known case of long-standing meningomyelocele (MMC) and presented with its potential complications such as difficult airway and restrictive lung disease. We describe the successful anaesthetic management of a case of anticipated difficult airway and postoperative hypoventilation as a sequel of kyphosis due to MMC. Her airway was secured with fibre optic-guided intubation in a semirecumbent position. Postoperative hypoventilation, hypercarbia and respiratory acidosis were managed conservatively, followed by staged weaning in the intensive care unit. Obstruction of the catheterisable continent channel of the neurogenic bladder itself may present with uropathy and urosepsis, which were also taken care of preoperatively.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

“…224–227,300–303 Case reports also observed successful intubation with flexible intubation scopes (Category B4-B evidence ). 304–356…”

Decreased respiratory performance of children and adolescents with myelomeningocele who use a wheelchair – preliminary data

“…Therefore, it is important to note that, even in the absence of respiratory symptoms and complaints, respiratory changes may be present and progress throughout the life of MMC patients, mainly for wheelchair-users. These changes are very important for the evaluation and follow-up of these patients, suggesting the need for early planning and preventive interventions in respiratory and motor physical therapy to increase quality of life and prevent possible pulmonary complications in these patients, especially after surgery (16).…”

Meningomyelocele with kyphoscoliosis: Ventilation challenges for anesthesiologist

“…MMC repair surgeries thus pose a challenge due to these associated clinical conditions. [ 3 ] Thoracic kyphoscoliosis produces significant restriction in lung function and makes controlled ventilation difficult. Special positioning requirements of the surgery further complicate the ventilation–perfusion mismatch, thus increasing the EtCO 2 –PaCO 2 gradient.…”