Craniosynostosis: A challenge for Anaesthetist
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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.