Burns,Neurology,Hydrocephalus,Myelomeningocele and Encephalocele

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ANESTHESIA AND ASSOCIATED DISEASES

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

Burns:

After the acute phase of their injury, children who have extensive burns require repeated anesthesia for plastic and reconstructive surgery.

Problems:

Contractures resulting from burns of the face and neck may make intubation and maintenance of the airway during anesthesia very difficult.
Succinylcholine is contraindicated for 2-3 months after severe burns (It may cause cardiac arrest secondary to hyperkalemia.
Blood loss may be large during grafting of extensive burns.
Temperature homeostasis is impaired and special measures must be taken to avoid excessive heat loss.
Infection of burns is a serious hazard at this stage. Observe great care in handling the patient in order to prevent cross infections; use reverse isolation techniques in the operating room and post-operatively.
Hepatic dysfunction may follow burns recovery and takes several weeks.
Emergence from anesthesia should be quiet in order to avoid damage to recently grafted areas.

Neurology:

General principles:

Peri-operative management must be planned to minimize the possibility of increasing the intra-cranial pressure.
Light GA is adequate for neurosurgery procedure. All anesthetic drugs used should be short acting, capable of being rapidly eliminated, or completely reversible. This ensures that the patient speedily emerges from anesthesia and that accurate continuous neuro-surgical assessment is possible.
Post-operative pain is not severe following intracranial surgery. Potent analgesics are unnecessary and may cause ventilatory depression, they therefore should not be used.

Hydrocephalus: Hydrocephalus may be due to a congenital defect ( e.g. Arnold Chiari malformation, aqueduct stenosis) or acquired disease ( e.g. tumor). In the newborn, hydrocephalus is most commonly secondary to Arnold Chiari malformations.

Problems:

Exercise special care if the ICP is increased. The patient should be watched carefully until surgery can be arranged as his condition may deteriorate suddenly, necessitating immediate ventricular tap or lumbar puncture.
If the patient becomes apneic; intubate, ventilate and arrange for an immediate ventricular tap.
Pre-medication: only atropine; preferably intravenous at induction.
Do not give opioid analgesics.

Myelomeningocele and Encephalocele: It may result from failure of the neural tube to fuse in the fetus. The incidence of myelomeningocele is approximately 1- 4/1000 live births; with a large geographic locations. Encephalocele is much less common.

Associated conditions: Hydrocephalus, in many cases with aqueductal stenosis occurs in 80% of infants with myelomeningocele or encephalocele.

Special problems:

Potential difficulty in positioning the patient for intubation.
Blood losses are
- Difficult to measure
- May be considerable
Difficulty in controlling heat loss during surgery

Next : Aneasthesia in Ophthalomology

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