Video-Laryngoscope For Difficult Paediatric Airway Management In A Case Of Meningomyelocele For Emergency Ventriculo Peritoneal Shunt Surgery

Abstract

Administering anaesthesia in the pediatric population is challenging because of various physiological and anatomical changes in them compared to adults. It becomes more difficult when associated with congenital anomalies. One of the major anaesthetic challenges in meningomyelocele (MMC) includes securing the airway with proper positioning of the child. The airway becomes a challenge, especially in small babies with associated congenital anomalies, raised intracranial pressure (ICP), and in emergency presentations with upper airway obstruction. Here is a case report of a 5-month-old 6 kg baby with big lumbar MMC and hydrocephalus, raised intracranial pressure with grunting noise indicating upper airway obstruction with respiratory distress for emergency ventriculo-peritoneal shunt placement. Video laryngoscopy (C-MAC)® with pediatric Millers blade was used as the first choice as a difficult airway was anticipated and helped us secure a difficult airway within seconds without any rise in ICP. The baby was placed supine for surgery while avoiding any pressure on the swelling to prevent its rupture, cerebrospinal fluid leak, or increase in ICP. Apart from airway control, intraoperative anaesthetic management in this case of V-P shunt also included proper positioning of large MMC, prevention of any rise in ICP, and prevention of hypothermia. Keywords: Video-laryngoscope, Pediatric millers blade, Difficult pediatric airway, Meningomyelocele, Ventriculo-peritoneal shunt.