Management of Congenital Neurological Defects: Anaesthesiologist’s Challenge

Abstract

Lumbosacral meningomyelocele and hydrocephalus are two major congenital neurological defects in paediatric patients. METHODSWe have discussed management of two cases, one of large meningomyelocele and second of massive hydrocephalus. Both cases were done successfully under general anaesthesia taking care of proper positioning. Child with meningomyelocele was positioned supine on two sand bags, creating a doughnut shaped depression to accommodate the meningomyelocele. Patient with hydrocephalus was placed on 25cms high pillow with head on a high head ring and an assistant's hand supporting the head while intubation. RESULTSMajor challenges for anaesthesiologist in these patients include airway management with proper positioning, replacement of blood and fluid losses and maintenance of body temperature.