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Airtraq - A Rescue Intubation Device in Huge Neonatal Occipital Encephalocoele in Lateral Position


Affiliations
1 Department of Anaesthesiology, Jawaharlal Nehru Medical College, AMU, Aligarh, India
 

Encephalocoele consists of herniation of Cerebrospinal Fluid (CSF), meninges and brain tissue through a congenital bony defect in the cranium. Anaesthetic challenges associated with a huge occipital encephalocoele include difficult airway, prone positioning and its complications, and accurate assessment of CSF and blood loss. We describe a case of a 5-day male, first child from a non-consanguineous marriage who was admitted with a huge occipital encephalocoele with micrognathia. In view of anticipated difficult intubation, the baby was induced with sevoflurane and intubated in spontaneously breathing with the help of infant size 0 Airtraq optical laryngoscope device in lateral position after one failed intubation attempt with direct laryngoscopy in supine. The intraoperative course remained uneventful. Recovery from anaesthesia was satisfactory and postoperative course was uneventful. After monitoring in the Intensive Care Unit for a day, the patient was shifted to the ward and discharged on the 10th post-operative day with advice for regular follow up.

Keywords

Amniotic Band Syndrome, High Arched Palate, Syndactyly.
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  • Walia B, Bhargava P, Shandu K. Giant occipital encephalocele. MJAFI. 2005; 61:293-4. https://doi.org/10.1016/S0377-1237(05)80181-9

  • Simpson DA, David DJ, White J. Cephaloceles: Treatment, outcome and antenatal diagnosis. Neurosurgery. 1984; 15:14-21. https://doi. org/10.1227/00006123-198407000-00005 PMid:6472590

  • Chatterjee MS, Bondoc B, Adhate A. Prenatal diagnosis of occipital encephalocele. Am J Obstet Gynecol. 1985; 153:646-7. https://doi.org/10.1016/S0002-9378(85)80250-7

  • Mayer U, Klinger M, Rott HD. A rare form of optical, choroidal and retinal dysplasia combined with an occipital encephalocele. Graefes Arch Clin Exp Ophthalmol. 1982; 219:72. https://doi.org/10.1007/BF02173444 PMid:6814985

  • Chen CP, Liu FF, Jan SW, Wang KG, Lan CC. Prenatal diagnosis of partial monosomy 13q associated with occipital encephalocele in a foetus. Prenat Diagn. 1996; 16:664-6. https://doi.org/10.1002/(SICI)1097-0223(199607)16:7 <664::AID-PD924>3.0.CO;2-K

  • Paladini D, Morra T, Teodoro A, Lamberti A, Tremolaterra F, Martinelli P. Objective diagnosis of micrognathia in the fetus: The jaw index. Obstet Gynecol. 1999; 93:382-6. https://doi.org/10.1016/S0029-7844(98)00414-1 PMid:10074984

  • Gunn TR, Tonkin SL, Hadden W, Davis SL, Gunn AJ. Neonatal micrognathia is associated with small upper airways on radiographic measurement. Acta Paediatr. 2000; 89:82-7. https://doi.org/10.1111/j.1651-2227.2000.tb01193.x PMid:10677064

  • Creighton RE, Relton JES, Meridy HW. Anaesthesia for occipital encephalocele. Can Anaesth Soc J. 1974; 21(1974):403-6 https://doi.org/10.1007/BF03006074 PMid:4836919

  • Singh CV. Anaesthetic management of meningocele and meningomyelocele. J Indian Med Assoc. 1980; 75(6):130-2. PMid:7229414

  • Singh KV, Garasia MB, Ambardekar M, Thota R, Dewoolkar LV, Mehta K. Giant occipital meningoencephalocele: anaesthetic implications. Inter J Anesthesiol. 2007; 13(2007):2.

  • Charles JC, Ronald DM. Miller’s Anaesthesia, 7th ed. chapter: 82. Pediatric Anesthesia. Churchill Livingstone; 2010. p. 2589.

  • Walia P, Bhargawa P, Sandhu K. Giant occipital encephalocele. Armed Forces Med J India. 2005; 61:293-94. https://doi.org/10.1016/S0377-1237(05)80181-9

  • Goel V, Dogra N, Khandelwal M, Chaudhri RS. Management of neonatal giant occipital encephalocele: Anaesthetic challenge. Indian J Anaesth. 2010; 54:477-8. https://doi.org/10.4103/0019-5049.71022 PMid:21189892 PMCid:PMC2991664

  • Manhas Y, Chinnan NK, Singh AK. Neonatal airway management in occipital encephalocele. Anesthesia and Analgesia, 103 (6) (2006), p. 1632 https://doi.org/10.1213/01.ane.0000247194.66024.d0 PMid: 17122307

  • Mowafi HA, Sheikh BY, Al-Ghamdi AA. Positioning for anesthetic induction of neonates with encephalocele. Inter J Anesthesiol. 2000; 5(3).

  • Prasad MK, Sinha AK, Bhadani UK, Chabra B, Rani K, Srivastava B. Management of difficult airway in penetrating cervical spine injury. Indian J Anaesth. 2010; 54:59-61. [PMC free article] [PubMed] https://doi.org/10.4103/0019-5049.60501 PMid:20532076 PMCid:PMC2876915

  • Komatsu R, Nagata O, Sessler DI, Ozaki M. The intubating laryngeal mask airway facilitates tracheal intubation in the lateral position. Anesth Analg. 2004; 98:858-61. [PMC free article] [PubMed] https://doi.org/10.1213/01. ANE.0000100741.46539.6B PMid:14980953 PMCid:PMC1350644

  • Cheng KI, Chu KS, Chau SW, Ying SL, Hsu HT, Chang YL, et al. Light wand-assisted intubation of patients in the lateral decubitus position. Anesth Analg. 2004; 99:279-83. [PubMed] https://doi.org/10.1213/01.ANE.0000118103.78553.06 PMid:15281544

  • Wang PK, Luo PH, Chen A, Chen TY, Lai HY. Emergency tracheal intubation in an ankylosing spondylitis patient in the lateral position using the Glidescope. Acta Anaesthesiol Taiwan. 2008; 46:80-1.[PubMed] https://doi.org/10.1016/S1875-4597(08)60031-4

  • Jain D, Mehta S, Gandhi K, Arora S, Parikh B, Abas M, von UngernSternberg B. Comparison of intubation conditions with CMAC Miller videolaryngoscope and conventional Miller laryngoscope in lateral position in infants: A prospective randomized trial. Pediatric Anesthesia. 2018; 28(3)226. https://doi.org/10.1111/pan.13316 PMid:29316004

  • Holm-Knudsen R. The difficult pediatric airway- a review of new devices for indirect laryngoscopy in children younger than two years of age. Pediatr Anesth. 2011; 21:98-103. https://doi.org/10.1111/j.1460-9592.2010.03487.x

  • Vlatten A, Soder C. Airtraq optical laryngoscope intubation in a 5-month-old infant with a difficult airway because of Robin sequence. Pediatr Anesth. 2009; 19(2009):699-700. https://doi.org/10.1111/j.1460-9592.2009.03038.x PMid:19638117

  • Sbaraglia F, Lorusso R, Garra R, Sammartino M. Usefulness of Airtraq in a 3-month-old child with Apert syndrome. Pediatr Anesth. 2011; 21:984-5. https://doi.org/10.1111/j.1460-9592.2011.03601.x

  • Pean D, Desdoits A, Asthenone K, Lejus C. Airtraq laryngoscope for intubation in Treacher Collins syndrome. Pediatr Anesth. 2009; 19:698-9. https://doi.org/10.1111/j.1460-9592.2009.02970.x PMid: 19638116

  • AlI QE, Das B, Amir SH, Firdaus U, Azhar AZ. Tracheal intubation with size 1 Airtraq in a 3 month old child with occipital meningocele: A novel experience. Egyptian Journal of Anaesthesia. 2013 Jan; 29(1):83-85. https://doi.org/10.1016/j.egja.2012.08.007


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  • Airtraq - A Rescue Intubation Device in Huge Neonatal Occipital Encephalocoele in Lateral Position

Abstract Views: 286  |  PDF Views: 103

Authors

Shahna Ali
Department of Anaesthesiology, Jawaharlal Nehru Medical College, AMU, Aligarh, India
Manazir Athar
Department of Anaesthesiology, Jawaharlal Nehru Medical College, AMU, Aligarh, India
S. Moied Ahmed
Department of Anaesthesiology, Jawaharlal Nehru Medical College, AMU, Aligarh, India
Obaid Ahmad Siddiqui
Department of Anaesthesiology, Jawaharlal Nehru Medical College, AMU, Aligarh, India

Abstract


Encephalocoele consists of herniation of Cerebrospinal Fluid (CSF), meninges and brain tissue through a congenital bony defect in the cranium. Anaesthetic challenges associated with a huge occipital encephalocoele include difficult airway, prone positioning and its complications, and accurate assessment of CSF and blood loss. We describe a case of a 5-day male, first child from a non-consanguineous marriage who was admitted with a huge occipital encephalocoele with micrognathia. In view of anticipated difficult intubation, the baby was induced with sevoflurane and intubated in spontaneously breathing with the help of infant size 0 Airtraq optical laryngoscope device in lateral position after one failed intubation attempt with direct laryngoscopy in supine. The intraoperative course remained uneventful. Recovery from anaesthesia was satisfactory and postoperative course was uneventful. After monitoring in the Intensive Care Unit for a day, the patient was shifted to the ward and discharged on the 10th post-operative day with advice for regular follow up.

Keywords


Amniotic Band Syndrome, High Arched Palate, Syndactyly.

References