[Anesthetic management of an infant girl with cloverleaf syndrome]

Area of Science:

• Pediatric Anesthesiology
• Neurosurgery
• Medical Genetics

Background:

• Cloverleaf syndrome presents with severe skull and facial deformities, often complicated by craniosynostosis and hydrocephalus.
• Infants with Cloverleaf syndrome require complex surgical interventions, necessitating specialized anesthetic considerations.

Observation:

• An infant girl with Cloverleaf syndrome underwent multiple surgical procedures including posterior-cranioplasty, foramen magnum decompression, ventriculo-peritoneal shunting, and cranioplasty.
• General anesthesia was induced using oxygen, sevoflurane, nitrous oxide, and thiopental, followed by orotracheal intubation with vecuronium.
• Anesthetic management focused on monitoring intracranial pressure and anticipating massive hemorrhage, especially during cranioplasty.

Findings:

• The infant's multiple surgeries were managed under general anesthesia without significant complications.
• Successful airway maintenance and ventilation were achieved in all procedures.
• Postoperative recovery was uneventful.

Implications:

• Anesthesiologists must be aware of the unique challenges associated with Cloverleaf syndrome, including significant intracranial pressure and anatomical abnormalities.
• This case highlights the feasibility of managing complex pediatric neurosurgical cases in infants with Cloverleaf syndrome with meticulous anesthetic planning.
• Effective anesthetic protocols can ensure favorable outcomes for infants undergoing extensive cranial reconstruction and management of associated conditions.