Author(s): Ravindra S. Giri1, Samudyatha T. J2
INTRODUCTION: Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism.1 Anaesthetic challenges in management of occipital meningoencephalocele include securing the airway with intubation in lateral position, intraoperative prone position and its associated complications, careful securing of the endotracheal tube and accurate assessment of blood loss. These babies also have associated congenital anomalies, gastrointestinal malrotation, renal anomalies, cardiac malformations and tracheoesophageal fistula, making anaesthetic management even more difficult. Meticulous anaesthetic management is crucial for early repair of encephalocoele to prevent any sequel.2
METHODS: To identify the anaesthetic challenges, perioperative and postoperative complications during encephalocele repair, 20 cases were studied retrospectively from 2012 to 2014 at Department of Anaesthesia, Department of Neurosurgery, MR Medical College, Gulbarga.
RESULTS: 20 cases of encephalocoele repair were undertaken during the study period. Out of these 12 (60%) were male and 8(40%) female. Age range was 1 day to 6 years. Most common type of encephalocele was occipital 12(60%), which posed a difficulty during positioning & intubation, followed by occipito- cervical 4(20%), Parietal 2(10%), Fronto- nasal 1(5%) & Fronto- naso- ethmoidal 1(5%). Most of the patients were extubated successfully on table, only one patient required post-operative ventilator support for a day. Peri-operative complications included bronchospasm (15%), followed by hypotension, tachycardia, laryngospasm, hypoxia, accidental extubation (10% each) & bradycardia, endobronchial intubation (5%)
CONCLUSION: Children with Encephalocoele are prone to have peri-operative complications which can be managed by meticulous anaesthetic managenement.3 Early surgical management of encephalocoele is not only for cosmetic reasons but also to prevent tethering, rupture and future neurological deficits.