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Perioperative management of children with encephalocele: an institutional experience
Charu Mahajan1, Girija Prasad Rath, Hari H Dash
1Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Surgical repair of encephaloceles in children presents anesthetic challenges beyond difficult airways. Associated conditions like hydrocephalus and large sac size significantly impact outcomes and require careful management.
Area of Science:
- Pediatric Neurosurgery
- Anesthesiology
- Congenital Malformations
Background:
- Encephaloceles are neural tube defects involving protrusion of brain and meninges through cranial defects.
- Pediatric anesthesia and airway management pose significant challenges during surgical correction of encephaloceles.
Purpose of the Study:
- To retrospectively analyze anesthetic management and perioperative outcomes in children undergoing encephalocele repair.
- To identify factors influencing complications and outcomes in pediatric encephalocele surgery.
Main Methods:
- Retrospective analysis of medical records for 118 children who underwent encephalocele excision and repair over 10 years.
- Review of data including associated anomalies, anesthetic management, perioperative complications, and discharge outcomes.
Main Results:
- Occipital encephaloceles (67%) were most common; giant encephaloceles occurred in 15.3%.
- Hydrocephalus (45.8%) was a frequent complication, particularly with occipital lesions.
- Difficult mask ventilation (5.9%) and intubation (19.5%) were noted; prolonged hospital stays correlated with hydrocephalus, meningitis, and respiratory infections.
Conclusions:
- Anesthetic management for pediatric encephalocele repair requires addressing not only airway difficulties but also associated congenital malformations, hydrocephalus, sac size, and hemodynamic instability.
- Comprehensive preoperative assessment and perioperative monitoring are crucial for optimizing outcomes in children with encephaloceles.
Background:
Encephaloceles are neural tube defects that are characterized by protrusion of the brain and meninges through a defect in the cranium. The inherent implications of pediatric anesthesia and difficult airway make surgical correction challenging for anesthesiologists
Methods:
Available medical records of 118 children who underwent excision and repair of encephalocele over a period of 10 years were analyzed retrospectively. Data on associated anomalies, anesthetic management, perioperative complications, and outcome at discharge were reviewed.
Results:
The average age of presentation was 1 year and 6 months. The most common site of lesion was the occiput (67%). Encephaloceles were giant (size of sac larger than the head) in 15.3% of children. Hydrocephalus was the most common complication (45.8%) and was predominantly associated in children with occipital encephaloceles (P=0.00). Difficult mask ventilation and intubation were encountered in 5.9% and 19.5% of children, respectively. In children with occipital encephalocele, the trachea was intubated commonly by direct laryngoscopy in the lateral position (47.5%). The average blood loss was 69.6±13.2 mL, and 56 children required transfusion, the average being 13.2±9.6 mL/kg. Intraoperative hemodynamic disturbances and respiratory complications were observed in 21.1% and 13.5% of children, respectively. The mean intensive care unit and hospital stay were 1.8±2.1 and 8.6±4.9 days, respectively. The stays were prolonged significantly whenever the children developed hydrocephalus, meningitis, and respiratory infection, predisposing to poor outcome.
Conclusions:
Difficult airway is not the only concern in children with encephalocele, but associated congenital malformations, hydrocephalus, large size of sac, and hemodynamic disturbances all require careful consideration.
