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Journal of Case Reports
Pediatric Difficult Intubation: A Newborn baby with a Giant Occipital Meningoceole
Mozibul Haque, Abul Kalam Azad, Md Rabiul Alam
Combined Military Hospital, Dhaka Cantonment, Dhaka 1206, Bangladesh.
Corresponding Author:
Dr (Brig Gen) Mozibul Haque
Email: colmhaque@yahoo.com
Received: 02-JUN-2019 Accepted: 09-NOV-2019 Published Online: 20-NOV-2019
DOI: http://dx.doi.org/10.17659/01.2019.0063
Background: Cranial meningocele represents herniation of the cranial meninges containing cerebrospinal fluid through a congenital neural defect in the cranium. A meningocele poses many challenges to the anaesthesiologists when presents for surgical excision and repair. Difficult or failed intubation frequently happen due to improper positioning and limited head excursion. Case Report: We encountered a giant bilobulated occipital meningocele in an 8-day male neonate weighing 3.8 kilogram. We placed the baby supine on a firm pillow. The meningocele sac was beyond the edge of the pillow supported by appropriately sized padded “doughnut”. We encountered difficult intubation as anticipated due to restricted head and neck movement. The laryngoscopic view of the glottis initially was Cormack-Lehane Grade 3. Once the assistant pressed over the larynx the Cormack-Lehane Grade became 2 and the tracheal intubation was possible. Then the baby was placed in lateral position carefully as surgery was planned to be performed in this position. Conclusion: Anaesthetic management of a case of a giant occipital meningocele demands identification of the problems and a management plan accordingly. Anaesthesiologist sometimes may need to adopt unconventional and innovative ideas to handle such cases.
Keywords : Anesthesiologists, Intratracheal Intubation, Meningocele, Neck, Newborn.
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