title: Perioperative Management of Children With Giant Encephalocele: A Clinical Report of 29 Cases.
abstract: BACKGROUND
  Giant encephalocele, a rare entity, makes anesthesiologists wary of challenging anesthetic course. Apart from inherent challenges of pediatric anesthesia, the anesthesiologist has to deal with unusual positioning, difficult tracheal intubation, and associated anomalies during the perioperative course.
  
  
  METHODS
  Medical records of 29 children with giant encephalocele, who underwent excision and repair, during a period of 13 years, were retrospectively analyzed. Data pertaining to anesthetic management, perioperative complications, and outcome at discharge were reviewed.
  
  
  RESULTS
  The average age at admission was 164 days. Hydrocephalus and delayed milestones were present in 19 (65.5%) and 7 (24.1%) children, respectively. Difficulty in tracheal intubation was encountered, in 15 (51.7%) children. Tracheal intubation was attempted with direct laryngoscopy, most often, in lateral position (24 [82.8%]). Intraoperative hemodynamic and respiratory complications were observed in 9 (31.0%) and 5 (17.2%) children, respectively. Intraoperative hypothermia was observed in 4 (13.8%) children. The average stay in the intensive care unit was 2.7 days and average hospital stay was 11.5 days. The condition at discharge remained same as the preoperative period in 24 children (82.7%), deteriorated in 2 (6.9%), and 3 children (10.3%) died.
  
  
  CONCLUSIONS
  Management of children with giant encephalocele requires the updated knowledge on possible difficulties encountered during the perioperative period. They need specialized anesthetic care for dealing with difficult tracheal intubation, associated congenital anomalies, unusual positioning, electrolyte abnormalities, hypothermia, and cardiorespiratory disturbances. For securing the airway, we suggest the practice of direct laryngoscopy in lateral position after inhalational induction. Muscle relaxant should be administered only after visualization of the glottis.
authors: *Department of Neuroanaesthesiology & Critical Care, Neurosciences Centre †Neurosurgery, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India.
authors: Charu
authors: C
authors: Mahajan
authors: Girija P
authors: GP
authors: Rath
authors: Parmod K
authors: PK
authors: Bithal
authors: Ashok K
authors: AK
authors: Mahapatra
mesh_terms: D000768:Anesthesia, General; D003422:Critical Care; D004677:Encephalocele / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000628:therapy; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D007902:Length of Stay; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies