Anaesthetic management of a newborn with occipital meningoencephaloceleexcision

Abstract

Meningoencephalocele is herniation of CSF and meninges along with brain tissue through a defect in the skull. It is challenging to the anaesthesiologist because of the presence of huge swelling over the posterior aspect of the neck resulting in inadequate extension of the neck and inability to lay down the neonate in supine position. The authors report a case of a 18 day old neonate weighing 2.4kg with a huge occipital meningoencephalocele (80x76mm), scheduled for excision. There were no signs of meningeal irritation, convulsion, no other signs of raised intracranial pressure and no neurological deficit. CVS and RS examinations were normal. The airway management was challenging as expected, hence before intubation pre oxygenation was done for 5 minutes in lateral position using a donut ring to support and stabilize the swelling and intubation was done in lateral position, the modified Cromack-Lenke score was found to be 2b, hence Burp manoeuvre was used to aid in intubation. Intra operatively patient was managed successfully and extubated on table. Postoperative stay in NICU was uneventful and discharged on post-operative day12.