Anaesthetic Challenges and Management of Myelomeningocele Repair

IntroductIon: Failure of neural tube closure early in intrauterine development results in spectrum of abnormalities ranging from spinabifidaocculta, a relativelybenigncondition to meningomyeocele, an abnormality involving vertebral bodies, spinal cord and brainstem. These babies also have associated congenital anomaliese.g.intestinalmalrotation, renal anomalies, cardiac malformations and tracheoesophageal fistula.Anaesthesiafor meningomyelocele always poses a challenge to anaesthesiologist as one has to deal with neonates and infants who already have so many anatomical and physiological differences compare to the adults or normal children.Meticulous anaesthetic management is crucial for early repair and to prevent sequele of meningomyelocele. Methods: To identify the anaesthetic challenges, perioperative and postoperative complications during myelomeningocelerepair, a retrospective study has been carried out on all the children operated during April 2006 to March 2011 at National Academy of Medical Sciences, Bir hospital, Kathmandu. All together 37 babies were operated on during the study period of which 59.5% were male and 40.5% were female. results: Overall complications were seen in 64.9% and the most common complications were respiratory like laryngospasm, bronchospasm, hypoxemia and endobronchial intubation. Most of the complications were manageable through early and precise diagnosis. conclusIon: Children with Myelomeningocele are prone to have peri-operative conclusions which can be managed by meticulous anaesthetic managenement. key words: Meningomyelocele, MMC, hydrocephalus, general anaesthesia, complication.