Surgery for brain abscess in children with cyanotic heart disease: An anesthetic challenge

Abstract

Context:Patients with cyanotic congenital heart disease (cCHD) are prone to develop frequent brain abscesses. Surgery for these abscesses is often limited to aspiration under local anesthesia because excision under general anesthesia (GA) is considered a riskier option. Perioperative hemodynamic instability, cyanotic spells, coagulation defects, electrolyte and acid base imbalance, and sudden cardiac arrest are among the major anesthetic concerns. Most of our current knowledge in this area has been gained from a neurosurgical standpoint while there is a paucity of corresponding anesthesia literature.Aims:To highlight the anesthesia issues involved in cCHD children undergoing brain abscess excision under GA.Settings and Design:Retrospective study of our institutional experience over a 5 year period.Materials and Methods:Of all the children with cCHD who underwent brain abscess surgery from January 2005 to December 2009, only 4 were operated under GA. Surgery was done after correcting fever, dehydration, electrolyte imbalance, coagulopathy and acid-base abnormalities, and taking appropriate intraoperative steps to maintain hemodynamic stability and prevent cyanotic spells and arrhythmias. Results: All 4 patients had a successful abscess excision though with varying degrees of intraoperative problems. There was one death, on postoperative day 34, due to septicemia. Conclusions: Brain abscess excision under GA in children of cCHD can be safely carried out with proper planning and attention to detail.

Brain Abscess in Undiagnosed Tetralogy of Fallot

“…Anesthetic management of these patients is always a challenge for the anesthetists because of the cardiopulmonary and coagulation abnormalities, dehydration and electrolyte imbalance, along with abscess-induced complications of seizures, meningitis and raised intracranial pressure [19].…”

Anaesthetic management for drainage of frontoparietal abscess in a patient of uncorrected Tetralogy of Fallot

“…Of all the patients with brain abscess and cyanotic congenital heart diseases, TOF is the most common in association (13–70% of the cases). [ 4 ] Prolonged survival with uncorrected TOF is associated with a well-developed left ventricle, mild to moderate PS with adaptations such as systemic-pulmonary collaterals, persistent patent ductus arteriosus or systemic hypertension. [ 2 ] The longevity of our patient is explained by a large bidirectional VSD.…”

Uncorrected tetralogy of Fallot's: Anesthetic challenges

“…[ 2 ] Most of the literature published regarding brain abscess management in patients with uncorrected TOF covers either conservative or surgical management and very few reports have been found regarding anesthetic planning and management. [ 3 4 ] Pediatric population itself pose anesthetist to a challenging situation and this manifolds when associated with CHD disease (uncorrected) with neurosurgical intervention. Chronic hypoxemia and right-to-left shunting cause significant alterations in pathophysiology which makes these patients more vulnerable to perioperative complications such as hemodynamic instability, congestive heart failure, arrhythmias, cyanotic spells, acid–base imbalance, coagulation defects, along with abscess-induced seizures, meningitis, and raised intracranial pressure.…”

“…Chronic hypoxemia and right-to-left shunting cause significant alterations in pathophysiology which makes these patients more vulnerable to perioperative complications such as hemodynamic instability, congestive heart failure, arrhythmias, cyanotic spells, acid–base imbalance, coagulation defects, along with abscess-induced seizures, meningitis, and raised intracranial pressure. [ 4 ] We are reporting here the anesthetic management of child with uncorrected TOF presenting with multiple brain abscesses who successfully underwent craniotomy with uneventful recovery.…”