Perioperative Management of Children With Encephalocele

Abstract

Encephaloceles are neural tube defects that are characterized by protrusion of the brain and meninges through a defect in the cranium. The inherent implications of pediatric anesthesia and difficult airway make surgical correction challenging for anesthesiologists Available medical records of 118 children who underwent excision and repair of encephalocele over a period of 10 years were analyzed retrospectively. Data on associated anomalies, anesthetic management, perioperative complications, and outcome at discharge were reviewed. The average age of presentation was 1 year and 6 months. The most common site of lesion was the occiput (67%). Encephaloceles were giant (size of sac larger than the head) in 15.3% of children. Hydrocephalus was the most common complication (45.8%) and was predominantly associated in children with occipital encephaloceles (P=0.00). Difficult mask ventilation and intubation were encountered in 5.9% and 19.5% of children, respectively. In children with occipital encephalocele, the trachea was intubated commonly by direct laryngoscopy in the lateral position (47.5%). The average blood loss was 69.6±13.2 mL, and 56 children required transfusion, the average being 13.2±9.6 mL/kg. Intraoperative hemodynamic disturbances and respiratory complications were observed in 21.1% and 13.5% of children, respectively. The mean intensive care unit and hospital stay were 1.8±2.1 and 8.6±4.9 days, respectively. The stays were prolonged significantly whenever the children developed hydrocephalus, meningitis, and respiratory infection, predisposing to poor outcome. Difficult airway is not the only concern in children with encephalocele, but associated congenital malformations, hydrocephalus, large size of sac, and hemodynamic disturbances all require careful consideration.