Diffuse Cerebral Atrophy, Central Sinus Venous Thrombosis, Hypoplastic Carpus Callosum, Adhd and Vsd in A Child; Anaesthestic Implications

Dr Narendra Kumar

《International Journal of Anesthesiology & Research (IJAR)》 2卷2期 (2014/03) Pp. 33-34

並列摘要

We report a 2.5 year old female child posted for squint surgery of both eyes under general anaesthesia. Child had microcephaly, subtle dysmorphic features, tracheostomy scar, global developmental delay and ADHD. Child also had diffuse cerebral atrophy, hypoplastic carpus callosum, acute on chronic central venous sinus thrombosis partially recanalised, subdural hygroma in left frontoparietal region and ventricular septal defect. ENT opinion was sought to rule out any bands within the trachea because of tracheostomy. Mother was accompanied with the patient in the operation theatre before induction to reduce the anxiety. Inhalational Induction was done in distraction technique with sevoflurane in an incremental manner quickly upto 8vol% via facemask. Direct laryngoscopy was done and trachea was incubated successfully in a second attempt. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane. Procedure took three and half hours. Patient tolerated anaesthesia well. Child was extubated after the child was completely awake. Propofol one mg/kg was given ten minutes before extubation to avoid emergence delirium. Inravenous methylprednisolone 10 mg was given intravenously to reduce the edema of the muscles (especially both medial rectus) which might reducethe incidence of bradycardia in postoperative period. Ondasetron 0.1 mg was given slowly i/v in the peri and postoperatively to reduce PONV (Both ADHD and squint surgery has increased risk of emesis). Child was monitored for seizures, bradycardia and other hemodynamic parameters in quiet intensive care environment.