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Journal of Case Reports
Anaesthetic Management of an Infant with a Giant Inter-Parietal Meningoencephalocele

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Avneesh Khare, Neelam Dogra, Avnish Bharadwaj, Priyanka Jain, Raksha Kundal     
From the Department of Anaesthesiology, SMS Medical College and Attached Group of Hospitals, Jaipur (Rajasthan), India.
Corresponding Author:
Dr. Avneesh Khare
Email: avneeshkhare@gmail.com
Received: 12-MAR-2014 Accepted: 05-MAY-2014 Published Online: 30-MAY-2014
DOI: http://dx.doi.org/10.17659/01.2014.0045
Abstract
Meningoencephalocele (MEC) consists of herniation of cerebrospinal fluid (CSF), meninges and brain tissue through a congenital bony defect in the cranium. Anesthetic challenges associated with a giant MEC include proper securing of airway, intra-operative prone position and its complications, accurate assessment of CSF and blood loss, etc. An active, 3 month old, first child from a non-consanguineous marriage with no other congenital anomaly was admitted with a giant inter-parietal MEC. MRI brain revealed a large midline inter-parietal MEC, containing small amount of brain and large volume of CSF. Baby was induced and intubated in supine position and operated upon in prone position. Sudden drainage of large volume of CSF occurred on opening the sac. It was accompanied with bradycardia, which was successfully managed with intravenous injection atropine. Thereafter, intra-operative course remained uneventful. Intraoperative losses were adequately replaced. Recovery from anesthesia was satisfactory and postoperative course was uneventful. After monitoring in ICU for a day, the patient was shifted to the ward and discharged on 10th post-operative day with advice for regular follow up.
Keywords : Analgesia, Anesthesia, Neuromuscular blockage, Prone position, Bradycardia, Meninges.
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