scholarly journals Perioperative Anesthetic Management in Preterm 12 Days Infants with Giant Meningoencephalocele at Mid Occipital and Secondary Trigonocephaly

2021 ◽  
Vol 4 (4) ◽  
Author(s):  
Kirby Saputra ◽  
◽  
Radian Ahmad Halimi
Keyword(s):  
Intracranial Pressure ◽  
Anesthetic Management ◽  
Fetal Distress ◽  
Anesthetic Techniques ◽  
Sudden Increase ◽  
Neural Element ◽  
Preoperative Preparation ◽  
Focal Neurological Deficit ◽  
Occipital Encephalocele ◽  
Sudden Decrease

Introduction: A meningoencephalocele is herniation of neural element along with meninges through a congenital defect in cranium. The incidence of encephalocele is approximately 1/5000 live births; occipital encephalocele is more common in females than males. It is called as giant meningoencephalocele when the head is smaller than the meningoencephalocele. These giant meningoencephaloceles harbor a large amount of cerebrospinal fluid (CSF) and brain tissue, so there occur various surgical challenges and anesthetic challenges in positioning and intubation. Case: A 12 days neonate was consulted to the neurosurgery department with complaints of large swelling over the back of head and difficulty in feeding. She was diagnosed with ventriculomegaly and meningoencephalocele since 32-33 pregnancy. The swelling was small at the time of birth, but it gradually increased in size. The child was born by section caesarean because of fetal distress and meningoenchepalocele. The neonate current weight was 3.195 grams with Post Conceptional Age (PCA) 35-36 weeks. On examination, the patient large spherical swelling was present over occipital region and there was no head control. The patient was active, conscious with no impression of focal neurological deficit. Systemic examination was unremarkable. The head circumference was 30 cm and circumference of occipital swelling was 40 cm. Potential problems in this patient include preoperative preparation and optimization of general condition, difficulty in positioning the patient, difficult airway (intubation), periodic apnea and potential hemodynamic disturbances and a sudden decrease in intracranial pressure during cele resection. Conclusion: Perioperative management in this case started from preoperative to postoperative evaluation. Preoperative preparation in anticipation of airway difficulties and communication with the operator is very important. Appropriate anesthetic techniques should aim to maintain stable hemodynamics and oxygenation and prevent a sudden increase or decrease in intracranial pressure.

scholarly journals Perioperative Anesthetic Management in Preterm 12 Days Infants with Giant Meningoencephalocele at Mid Occipital and Secondary Trigonocephaly

2021 ◽  
Author(s):  
Kirby Saputra ◽  
Radian Ahmad Halimi
Keyword(s):  
Intracranial Pressure ◽  
Anesthetic Management ◽  
Fetal Distress ◽  
Anesthetic Techniques ◽  
Sudden Increase ◽  
Neural Element ◽  
Preoperative Preparation ◽  
Focal Neurological Deficit ◽  
Occipital Encephalocele ◽  
Sudden Decrease

Introduction: A meningoencephalocele is herniation of neural element along with meninges through a congenital defect in cranium. The incidence of encephalocele is approximately 1/5000 live births; occipital encephalocele is more common in females than males. It is called as giant meningoencephalocele when the head is smaller than the meningoencephalocele. These giant meningoencephaloceles harbor a large amount of cerebrospinal fluid (CSF) and brain tissue, so there occur various surgical challenges and anesthetic challenges in positioning and intubation. Case: A 12 days neonate was consulted to the neurosurgery department with complaints of large swelling over the back of head and difficulty in feeding. She was diagnosed with ventriculomegaly and meningoencephalocele since 32-33 pregnancy. The swelling was small at the time of birth, but it gradually increased in size. The child was born by section caesarean because of fetal distress and meningoenchepalocele. The neonate current weight was 3.195 grams with Post Conceptional Age (PCA) 35-36 weeks. On examination, the patient large spherical swelling was present over occipital region and there was no head control. The patient was active, conscious with no impression of focal neurological deficit. Systemic examination was unremarkable. The head circumference was 30 cm and circumference of occipital swelling was 40 cm. Potential problems in this patient include preoperative preparation and optimization of general condition, difficulty in positioning the patient, difficult airway (intubation), periodic apnea and potential hemodynamic disturbances and a sudden decrease in intracranial pressure during cele resection. Conclusion: Perioperative management in this case started from preoperative to postoperative evaluation. Preoperative preparation in anticipation of airway difficulties and communication with the operator is very important. Appropriate anesthetic techniques should aim to maintain stable hemodynamics and oxygenation and prevent a sudden increase or decrease in intracranial pressure.

scholarly journals Anesthetic management for cesarean delivery in a woman with congenital atlantoaxial dislocation and Chiari type I anomaly: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuyan Nie ◽  
Weimin Zhou ◽  
Shaoqiang Huang
Keyword(s):  
Case Report ◽  
Cesarean Delivery ◽  
Anesthetic Management ◽  
Neurological Complications ◽  
Atlantoaxial Dislocation ◽  
Epidural Needle ◽  
Team Approach ◽  
Anesthetic Techniques ◽  
Type I ◽  
Combined Spinal Epidural Anesthesia

Abstract Background The preferable choice of anesthesia for the patients with congenital atlantoaxial dislocation (CAAD) and type I Arnold Chiari malformations (ACM-I) has been a very confusing issue in clinical practice. We describe the successful administration of combined spinal-epidural anesthesia for a woman with CAAD and ACM-1 accompanied by syringomyelia. Case presentation Our case report presents the successful management of a challenging obstetric patient with CAAD and ACM-1 accompanied by syringomyelia. She had high risks of difficult airway and aspiration. The injection of bolus drugs through the spinal or epidural needle may worsen the previous neurological complications. The patient was well evaluated with a multidisciplinary technique before surgery and the anesthesia was provided by a skilled anesthesiologist with slow spinal injection. Conclusions An interdisciplinary team approach is needed to weigh risks and benefits for patients with CAAD and ACM-1 undergoing cesarean delivery. Therefore, an individual anesthetic plan should be made basing on the available anesthetic equipments and physicians’ clinical experience on anesthetic techniques.

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

Mumps as a Cause of Hydrocephalus

PEDIATRICS ◽  
1972 ◽  
Vol 50 (2) ◽  
pp. 346-347
Author(s):  
J. Hower ◽  
H. E. Clar ◽  
M. Düchting
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Intracranial Pressure ◽  
Head Circumference ◽  
Aqueductal Stenosis ◽  
Sudden Increase ◽  
Increased Intracranial Pressure ◽  
Cerebrospinal Fluid Flow ◽  
Human Pathology ◽  
Experimental Findings

We read Dr. Bray's communication with great interest. With actually three cases of aqueductal stenosis after mumps being recorded we cannot doubt that the experimental findings of Johnson and Johnson have a bearing on human pathology. Our patient, a 6½-year-old boy, underwent evaluation of his megacephalus five months before the onset of mumps. At that time a pneumoencephalogram could be obtained by lumbar filling. Cerebrospinal fluid flow was considered marginally adequate. Three months after mumps meningoencephalitis the patient presented with symptoms of increased intracranial pressure (papilledema, sudden increase in head circumference, and widening of the coronar suture).

Clinical comparison of pain perception rates between computerized local anesthesia and conventional syringe in pediatric patients

2005 ◽  
Vol 29 (3) ◽  
pp. 239-243 ◽  
Author(s):  
Alma Luz San Martin-Lopez ◽  
Luis David Garrigos-Esparza ◽  
Gabriela Torre-Delgadillo ◽  
Antonio Gordillo-Moscoso ◽  
Juan Francisco Hernandez-Sierra ◽  
...  
Keyword(s):  
Analogue Scale ◽  
Pain Perception ◽  
Pediatric Patients ◽  
Anesthetic Management ◽  
Crossover Design ◽  
Anesthetic Techniques ◽  
Heart Rate Monitoring ◽  
Injection Device ◽  
To Receive ◽  
Injection Procedure

The purpose of this study was to evaluate pain perception rates in pediatric patients by comparing computerized injection device and traditional injection procedure. In a clinical trial, by using a crossover design, sixty-four patients were randomly assigned to receive, in consecutive sessions, dental anesthetic techniques with either traditional or computerized device. Visual Analogue Scale qualification and heart rate monitoring as physiologic indicator of pain response were used for the evaluation. Results showed that traditional syringe injections were more painful than computerized injection device (p&lt;0.001). Results suggested that computerized injection device reduces pain perception compared to the traditional syringe during the dental anesthetic management.

scholarly journals Anesthetic Management of a Pediatric Patient with Emanuel Syndrome

2021 ◽  
Author(s):  
Bengisu Ercan ◽  
Aysun Ankay Yılbaş ◽  
Özgür Canbay ◽  
Ümitcan Ünver
Keyword(s):  
Pediatric Patient ◽  
Anesthetic Management ◽  
Pediatric Intensive Care ◽  
Anesthetic Techniques ◽  
Repair Operation ◽  
Craniofacial Dysmorphism ◽  
Cleft Palate Repair ◽  
Intraoperative Period ◽  
Emanuel Syndrome ◽  
Isolated Cleft Palate

Emanuel syndrome is a very rare recessive hereditary disorder characterized by multiple congenital anomalies, craniofacial dysmorphism, significant developmental delay and mental retardation. In this case report, we discussed our anesthetic management of a pediatric patient with Emanuel Syndrome undergoing isolated cleft palate repair operation. General anesthesia was maintained with total intravenous anesthetic techniques. Videolaryngoscopy was used for endotracheal intubation. The patient was extubated at the operating room following an uneventful intraoperative period, however she developed respiratory distress and was reintubated and transferred to pediatric intensive care unit. Anesthesiologists should be prepared for difficult airway management because of concomitant micro-retrognathia, as in our patient. Most of the problems regarding anesthetic management of this extremely rare syndrome can be reduced by a detailed preoperative assesment, preparation for diffucult airway and a careful hemodynamic monitoring.

scholarly journals Anesthetic Management of Patient with Preeclampsia, Pulmonary Edema, and Peripartum Cardiomyopathy in Pregnancy Undergoing Caesarean Section: A Case Report

2021 ◽  
Author(s):  
Doddy Tavianto ◽  
Reza W Sudjud ◽  
Putri C Barliana ◽  
Indra Wijaya
Keyword(s):  
Pulmonary Edema ◽  
Myocardial Dysfunction ◽  
Anesthetic Management ◽  
Fetal Distress ◽  
Positive Pressure ◽  
Depressant Effect ◽  
Intubation Technique ◽  
Organ Systems ◽  
Disease Case ◽  
In Pregnancy

Preeclampsia is a disease that occurs in pregnancy after 20 weeks of gestation with manifestations involving multi organ systems such as pulmonary edema and ventricle dysfunction. Cardiomyopathy is a heart disorder characterized by myocardial dysfunction unrelated to any other previous heart disease. Case: A 31-year-old woman diagnosed with G1P0A0 full-term pregnancy, preeclampsia, pulmonary edema, cardiomyopathy, and fetal distress, who underwent cesarean section. On physical examination, shortness of breath was found in semi-Fowler position. Patient had high blood pressure and global hypokinesis was found on echocardiography results. She was planned for general anesthesia with semi-closed intubation technique and breath controlled. Anesthetic management should optimize the preoxygenation, provide positive pressure ventilation with positive end-expiratory pressure (PEEP), maintain the minimal myocardial depressant effect of drugs, and maintain a normovolemic state. It could improve the good outcomes. Conclusion: Three things that must be considered when starting the induction are oxygenation, fluid status, and selection of drugs that do not make the heart work harder. The combination of fentanyl, midazolam, and sevoflurane is the drug of choice used for induction, because it can minimize the cardiac depressant effect.

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