Anaesthetic Management of Interesting Case

1
Anaesthetic Management of Interesting Case

• Dr. V. Sankara Subramanian
• Consultant Anaesthesiologist
• Dr. Jeyasekharan Hospital
• Nagercoil.

2
Case

• Baby X a case of APERT SYNDROME with Incomplete
  cleft palate was posted for palatorplasty.

3
Brief Summary

• Baby was full term normal delivery baby
• No H/O of birth asphyxia
• H/o delayed milestones ()
• H/o epilepsy () and was on medications
• Last episode of fits 4 months back
• Congenital hydrocephalus (), VP shunt procedure
  done at the age of 5 years
• Age 7 years, Weight 12.5 Kgs

4
(No Transcript)
5
Pre op Assessment

• No verbalisation
• Large Head
• Syndactyly
• Macroglossia
• Micrognathia
• Maxillary hyper plasia
• CVS-RS Clinically normal
• P/A umbilical hernia

6
Anaesthetic Management

• IV line secured with difficulty
• Pre oxygenation done
• Inhalation induction 6 Sevoflurane N2O O2
• Trial laryngoscopy done, epiglottis visualised
• Induced with PROPOFOL 45 mg, FENTANYL 25 mic
• Orally intubated with 5 size uncuffed RAE tube
• Maintenance N2O O2 Atracurium Sevo
• Intraop uneventful baby
• Girl extubated on table, smooth postop

7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
Discussion

• Anticipating airway difficulty in paediatric
  population
• Syndrome associated with cleft lip / palate
• Apert Syndrome
• 1906 French Neurologist first described
• Mutation in a gene located on Ch10Q
• Incidence 165000
• Features
• Hyper hidrosis
• Craniosynostosis
• Chiarri malformation, Frontal Bossing,
  Development delay
• Low set ears
• Mid face development delay
• Associated ASD, VSD
• Syndactly

13
(No Transcript)
14
Thank You