Anaesthetic Management of Interesting Case
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Transcript of Anaesthetic Management of Interesting Case
Dr. V. Sankara SubramanianConsultant Anaesthesiologist
Dr. Jeyasekharan HospitalNagercoil.
Case
Baby X a case of APERT SYNDROME with Incomplete cleft palate was posted for palatorplasty.
Brief Summary
Baby was full term normal delivery baby No H/O of birth asphyxia H/o delayed milestones (+) H/o epilepsy (+) and was on medications Last episode of fits 4 months back Congenital hydrocephalus (+), VP shunt
procedure done at the age of 5 years Age 7 years, Weight – 12.5 Kgs
Pre op Assessment
No verbalisation Large Head + Syndactyly + Macroglossia + Micrognathia + Maxillary hyper plasia + CVS-RS – Clinically normal P/A – umbilical hernia +
Anaesthetic Management
IV line secured with difficulty Pre oxygenation done Inhalation induction : 6% Sevoflurane+ N2O +
O2 Trial laryngoscopy done, epiglottis visualised Induced with PROPOFOL 45 mg, FENTANYL 25
mic Orally intubated with 5 size uncuffed RAE
tube Maintenance N2O + O2 + Atracurium + Sevo Intraop – uneventful baby Girl extubated on table, smooth postop
Discussion Anticipating airway difficulty in paediatric population Syndrome associated with cleft lip / palate Apert Syndrome 1906 French Neurologist first described Mutation in a gene located on Ch:10Q Incidence – 1:65000 Features
Hyper hidrosis Craniosynostosis Chiarri malformation, Frontal Bossing, Development delay Low set ears Mid face – development delay Associated ASD, VSD Syndactly