Craniosynostosis: A challenge for Anaesthetist

{Dr Bilal Humayun Khan Durrani

ByDr Bilal Humayun Khan DurraniAnaesthesia DepartmentCMH Rawalpindi

CRANIOSYNOSTOSIS

A Challenge for Anaesthetist

INTRODUCTION

CASE PRESENTATION

PATIENT’S PROFILE

• Name: XYZ

• Age: 01 Year.

• Sex: Male

• Resident: Rawalpindi

• Admission: 18 Aug 2014

• Hospital: CMH

Rawalpindi

PRESENTING COMPLAINTS

• Unusually shaped head

• Irritability

• Difficulty in following objects

• Sluggish and slow responsiveness

EXAMINATION

VITAL SIGNS:Pulse: 140/minBlood Pressure: 75/35mmHgTemp: 98.6 FResp Rate: 24/min

OTHER SIGNSPallorEdema Jaundice --Dehydration +

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

INVESTIGATIONS

• CT Head: Rt Uni coronal Craniosynostosis

DIAGNOSISBased on history, examination and

investigations a diagnoses of Rt Unicoronal Asyndromic Craniosynostosis was made.

Patient was scheduled for Total Calvarial Reconstruction.

ANAESTHETIC CONSIDERATIONS

• Prolong duration of surgery

• Tube Displacement

• Hypothermia

• Blood loss

• Venous Air Embolism

• Fluid Management

• Analgesia

ANAESTHETIC MANAGEMENT

• Pre oxygenation With 100 % Oxygen was done

• Premedication Inj Nalbuphine Inj Metoclopramide

• Inhalational InductionUsing Sevoflurane @ 2 %


• 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


• Central Line Access in Rt Int Jugular Vein

• Art Line for Invasive Blood Pressure Monitoring

,

ANAESTHETIC MANAGEMENT• Temperature Regulation and control • Covering of extremities• Elevated room temperature• Forced air warming blankets• IV Fluid warmers

,


• Meticulous fluid management

• Maintaince fluid

• On-going losses

• Replacement of insensible losses

• Blood loss calculation

• Blood replacement ,

INTRAOPERATIVE MONITORING

• ECG• Pulse Oximetry• Heart Rate

• EtCO2

• Invasive Blood Pressure

• Central Venous Pressure

• Urine Output• Blood Loss

SURGICAL STEPS

• Tarsoraph

y

SURGICAL STEPS

• Tarsoraph

y

SURGICAL STEPS

• Incision

marking

SURGICAL STEPS

• Drapes

and

positionin

g

• Access to

airway

SURGICAL STEPS

• Scalp

elevation

• Periosteal

flap

marking

• Calvarium

elevation.

SURGICAL STEPS

• Bone

stripping

• Barrel

staving

SURGICAL STEPS

• Placemen

t of bone

strips.

SURGICAL STEPS

• Hemostasis

• Layered

closure

• Drains

POST OPERATIVE MANAGEMENT

• Reversal and Recovery





THANKYOU

• Surgical ICU

• Adequate analgesia

• Hydration

• Monitoring for complications

Healthcare

Craniosynostosis: A challenge for Anaesthetist