Chiari type I malformation and postoperative respiratory failure.
OBJECTIVE
To present a case of respiratory failure following suboccipital craniectomy for Chiari type I malformation.


METHODS
A 22-yr-old man presented with a two year history of symptoms and signs suggestive of brainstem compression at the level of the foramen magnum. This was confirmed with magnetic resonance imaging. The procedure of suboccipital craniectomy, upper cervical laminectomy and fourth ventricle exploration was performed. Three hours postoperatively the patient experienced episodes of apnea and subsequently became drowsy. Blood gas analysis revealed hypercapnic respiratory failure. Chest X-ray revealed evidence of pulmonary aspiration. The trachea was re-intubated and the lungs ventilated in intensive care for 72 hr. He was discharged home two weeks postoperatively.


CONCLUSIONS
Chiari type I malformation is associated with a number of associated anomalies. These patients are at considerable risk of respiratory depression and bulbar dysfunction in the perioperative period. The anesthetic issues are reviewed and discussed.
Williams
D L
DL
Department of Anesthesia, University of British Columbia, Vancouver, Canada.
Umedaly
H
H
Martin
I L
IL
Boulton
A
A
D000328:Adult; D000758:Anesthesia; D001784:Blood Gas Analysis; D002531:Cerebellum / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005539:Foramen Magnum / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D020546:Fourth Ventricle / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D016343:Monitoring, Intraoperative; D012121:Respiration, Artificial