Anesthetic concerns and perioperative complications in repair of myelomeningocele: a retrospective review of 135 cases.
Myelomeningocele (MMC) a complex congenital spinal anomaly, results from neural tube defect during first 4 weeks of gestation. Medical records of 135 children who underwent excision and repair of MMC from January 2003 to December 2006 were analyzed, retrospectively. Data on associated illnesses, anesthetic management, perioperative complications, and outcome were recorded. The patient population consisted of older infants with unrepaired MMC. The average age of presentation was 1 year and 8 months. The commonest site of presentation was lumbar (39.3%). Leaking MMC was present in 19.3% of cases, most had associated electrolyte imbalance. Hydrocephalus was the commonest association (67.4%) followed by Chiari-II malformation (58.4%). Renal abnormality was present in 9% of cases and 24.4% of children had scoliosis. Two infants (1.5%) presented with inspiratory stridor. Intraoperative cardiac and respiratory problems were observed in 15.6% and 11.1%, of cases, respectively. Two children (1.5%) suffered cardiac arrest; both had associated Chiari-II malformation and hydrocephalus. Postoperative ventilation was required in 8.9% of children, primarily due to inadequate reversal from neuromuscular blockade. Infection, cerebrospinal fluid leak, and pseudomeningocele were common surgical complications. Improvement of motor, sensory, and sphincteric function was observed in 30.5%, 22.9%, and 14.1%, respectively. To conclude, surgical repair of MMC may at times pose life-threatening complications mostly because of associated anomalies. Children with associated Chiari malformation and/or hydrocephalus need special attention during perioperative period.
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Deepak
D
Singh
Girija Prasad
GP
Rath
Hari H
HH
Dash
Parmod K
PK
Bithal
D000777:Anesthetics / Q000009:adverse effects*; D001139:Arnold-Chiari Malformation / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology; D007223:Infant; D007239:Infections / Q000453:epidemiology; D007431:Intraoperative Complications / Q000453:epidemiology*; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008588:Meningocele / Q000453:epidemiology / Q000209:etiology; D008591:Meningomyelocele / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012121:Respiration, Artificial / Q000379:methods; D012135:Respiratory Sounds; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology; D013353:Subdural Effusion / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
D000777:Anesthetics