Penatalaksanaan Anestesi Neonatus yang Menjalani Pembedahan Koreksi Giant Unruptured Occipital Meningoencephalocele

Abstract

Meningoencephalocele is a rare congenital abnormality where duramater and cranium failed to close completely, leaving part of intracranial tissues outside the cranium wrapped in a sac. Neonate’s airway management, pose many challenges due to immaturity of airway anatomy, limited respiratory organ reserve and extreme head-to-body ratios. Occipital meningoencephalocele will also complicate the intubation and airway control during anesthesia and surgery. A nine days old male patient with an occipital lump measuring 17x12x8 cm underwent meningoencephalocele resection. Induction of anesthesia was performed by sevoflurane inhalation, rocuronium to facilitate videolaryngoscopy and intubation in supine position, supported by doughnut-shape pads which fits the size of the cele. Videolaryngoscope was chosen because it provides optimal visualization without hyperextension and over manipulation than conventional laryngoscope, therefore intubation can be done in supine position. Anesthesia and surgery duration was 2 hours and 15 minutes. The patient was treated in the neonatal intensive care unit after surgery, extubated 24 hours later, and discharged home 10 days after surgery. The greatest challenge in anesthesia management for occipital meningoencephalocele resection is securing the airway while ensuring the sac is not ruptured during airway manipulation and positional changes during anesthesia and surgery.