Hydrocephalus and Anesthesia
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Hydrocephalus can be caused by closure of meningomyelocele, congenital aqueductal stenosis, or intraventricular hemorrhage in neonates. Clinical presentations include lethargy, vomiting, and cardio respiratory problems. For anesthesia, rapid sequence induction is preferred to avoid increases in intracranial pressure during intubation or crying. Volatile anesthetics, opioids, and nitrous oxide are not contraindicated due to open cranial sutures blunting pressure increases in neonates. Extubation depends on any intraoperative apnea or bradycardia. Surgical management involves placement of a ventriculo-peritoneal shunt.
Hydrocephalus and Anesthesia
- 1. HYDROCEPHALUS Speaker: Dr Bhagirath.S.N Moderator: Dr Sarika
- 2. Hydrocephalus Causes 1. After closure of meningomyelocele (if chiari II malformation is present) 2. Congenital (aqueductal stenosis) 3. Intraventricular hemorrhage Neonate 1. Cranial sutures are open-so pressure increases are blunted 2. But eventually, head increases in size and intra cranial pressure increases
- 3. Hydrocephalus Clinical presentation 1. Lethargy 2. Vomiting 3. Cardio respiratory problems Anesthetic Technique 1. Avoid increase in ICP secondary to awake tracheal intubation, crying, struggling, straining 2. Rapid sequence induction is preferred 3. Volatile anesthetic agents, opioid and nitrous oxide are not contraindicated. (Ketamine, Isoflurane, fentanyl) 4. Open-sutured cranium means there is no increase in intra cranial pressure secondary to Ketamine and volatile anesthetic administration. 5. Extubation depends on whether periods of intraoperative apnea & bradycardia were seen.