Craniosynostosis: A challenge for Anaesthetist
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The patient, a 1-year old male, presented with an unusually shaped head and developmental delays. Imaging revealed right unicoronal craniosynostosis requiring total calvarial reconstruction. The anesthetic management involved careful preparation, temperature control, fluid management, and close monitoring during the prolonged surgery due to risks of tube displacement, hypothermia, blood loss, and air embolism. Through meticulous care, the patient successfully underwent reconstruction and was recovered in the ICU with adequate analgesia and hydration.
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Craniosynostosis: A challenge for Anaesthetist
- 1. { Dr Bilal Humayun Khan Durrani
- 2. By Dr Bilal Humayun Khan Durrani Anaesthesia Department CMH Rawalpindi CRANIOSYNOSTOSIS A Challenge for Anaesthetist
- 3. INTRODUCTION
- 5. PATIENT’S PROFILE • Name: XYZ • Age: 01 Year. • Sex: Male • Resident: Rawalpindi • Admission: 18 Aug 2014 • Hospital: CMH Rawalpindi
- 6. PRESENTING COMPLAINTS • Unusually shaped head • Irritability • Difficulty in following objects • Sluggish and slow responsiveness
- 7. EXAMINATION VITAL SIGNS: Pulse: 140/min Blood Pressure: 75/35mmHg Temp: 98.6 F Resp Rate: 24/min OTHER SIGNS Pallor Edema Jaundice -- Dehydration +
- 8. INVESTIGATIONS • Blood Group: A + • Blood CP: Hb 11.1g/dl, Platelets 373000/cubic mm • Urine RE: NAD • S.LFT’s: ALT 40 U/l • S.RFT’S: Urea 5.3mmol/l, Creatinine 76µmol/l • Hepatitis Profile Negative • Coagulation: Normal • ECG: Normal • Electrolytes: Normal • Vaccination being done as per EPI Protocol
- 9. INVESTIGATIONS • CT Head: Rt Uni coronal Craniosynostosis
- 10. DIAGNOSIS Based on history, examination and investigations a diagnoses of Rt Unicoronal Asyndromic Craniosynostosis was made. Patient was scheduled for Total Calvarial Reconstruction.
- 11. ANAESTHETIC CONSIDERATIONS • Prolong duration of surgery • Tube Displacement • Hypothermia • Blood loss • Venous Air Embolism • Fluid Management • Analgesia
- 12. ANAESTHETIC MANAGEMENT • Pre oxygenation With 100 % Oxygen was done • Premedication Inj Nalbuphine Inj Metoclopramide • Inhalational Induction Using Sevoflurane @ 2 %
- 13. ANAESTHETIC MANAGEMENT • Intubation: Following injection of Atracurium 4 mg I/V a 3.5mm ID cuffed armored ETT was passed and secured. • Adhesive tapes • Tube Suturing • Circum mandibular fixation
- 14. ANAESTHETIC MANAGEMENT • Central Line Access in Rt Int Jugular Vein • Art Line for Invasive Blood Pressure Monitoring
- 15. ANAESTHETIC MANAGEMENT • Temperature Regulation and control • Covering of extremities • Elevated room temperature • Forced air warming blankets • IV Fluid warmers
- 16. ANAESTHETIC MANAGEMENT • Meticulous fluid management • Maintaince fluid • On-going losses • Replacement of insensible losses • Blood loss calculation • Blood replacement
- 17. INTRAOPERATIVE MONITORING • ECG • Pulse Oximetry • Heart Rate • EtCO2 • Invasive Blood Pressure • Central Venous Pressure • Urine Output • Blood Loss
- 21. SURGICAL STEPS • Drapes and positioning • Access to airway
- 22. SURGICAL STEPS • Scalp elevation • Periosteal flap marking • Calvarium elevation.
- 23. SURGICAL STEPS • Bone stripping • Barrel staving
- 24. SURGICAL STEPS • Placement of bone strips.
- 25. SURGICAL STEPS • Hemostasis • Layered closure • Drains
- 26. POST OPERATIVE MANAGEMENT • Reversal and Recovery
- 27. POST OPERATIVE MANAGEMENT • Reversal and Recovery
- 28. POST OPERATIVE MANAGEMENT • Reversal and Recovery
- 29. THANKYOU • Surgical ICU • Adequate analgesia • Hydration • Monitoring for complications
Editor's Notes
- My patient 24 yrs old is resident of rawalpindi and a house wife, reported to MH maternity OPD on 3rd of August as an emergency unbooked case, with complaints of
- Gestational amenorrhoea for the past 36 weeks, she had sustained high blood pressure for the past 05 weeks, she had generalized edema and recent onset headache for past 2 days, recently she had 2 episodes of vomiting.
- The patient was brought to OT as an emergency case for C-Section as there was fetal distress and impending eclampsia. Her pulse was 120/min, blood pressure 175/115, she was afebrile and resp rate was 18/min. She was pale, mildly dehydrated and had generalized oedema,
- Her blood group was A+, she had a haemoglobin of 9.1g/dl, with a platelet count of 130000, she had proteinuria, mildly raised ALT, raised urea and Creatinine, rest of the investigations were normal.
- Her blood group was A+, she had a haemoglobin of 9.1g/dl, with a platelet count of 130000, she had proteinuria, mildly raised ALT, raised urea and Creatinine, rest of the investigations were normal.
- On the basis of history, clinical examination and investigations a diagnosis of pre eclampsia was made. And patient was planned for emergency C-section under spinal anaesthesia.
- A loading dose of magnesium sulphate was given 4g iv followed by an IV infusion of magnesium sulphate 1g / hour. Infusion of Nitronal was also started intra op to control her blood pressure at 2mg/hr and was titrated according to blood pressure response.
- Non invasive and invasive, blood pressure monitoring along with pulse oximetery, ECG, heart rate, urine output and blood loss was closely monitored during the operation.