Anesthetic Considerations in Neonatal Neurosurgical Patients

Anaesthesia for spinal surgery in children

“…Specifically, the incidence of congenital heart disease is not increased in patients with CNS lesions; so, routine preoperative screening need not include a cardiology evaluation. 11 Vertebral defects may be associated with other congenital anomalies. The VACTERL syndrome-vertebral defects, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, renal (genitourinary), and limb malformations, is seen in 13% of children with tracheooesophageal fistula.…”

“…31 Meningoceles and myeloceles are usually repaired within the first day of life to minimize bacterial contamination of the exposed spinal cord and subsequent sepsis, which is the most common cause of death in this population during the newborn period. 11 The anaesthetic concerns relate to the size and maturity of the patient, and are summarized in Table 3. Repair of the myelomeningocele is usually the first of numerous surgeries that the child will require.…”

“…For repair of meningoceles and myelomeningoceles, tracheal intubation may need to be performed with the child in the lateral decubitus position or supine using a padded ring in order to protect the neuroplaque. 11 Induction can be by inhalation or i.v. type unless a difficult intubation is anticipated.…”