Background and objective:
Neural tube defect (myelodysplasia) is an abnormality in fusion of the embryologic neural groove during the first month of gestation. Failure of neural tube closure results in a sac-like herniation of the meninges (meningocele), or a herniation of neural elements (myelomeningocele). Repair of these defects is a surgical emergency and neonates should be operated on in the first 24 h of life for closure of the defect. The very young age of population and the nature of surgery lead to high rate of complication. The aim of this study was to evaluate the anaesthesia complications and our experience in this field.
Methods and materials:
We included 156 preterm and term neonates, 76 males and 80 females, who underwent surgical repair of these defects during the first 7 days of their life. Anaesthesia was maintained with inhalation of halothane or sevoflurane and fentanyl or intravenous ketamine and fentanyl. All the patients were bringing in prone position after intubation. Complications during anaesthesia and after extubation were registered. We also recorded time of operation, recovery time, level of defect and association with other anomalies.
In 6 (3.9%) patients with cervical meningocele, difficult intubation were recorded (Mallampati grade III). In 24 (15.4%) neonates, bleeding exceeding more than 20% of the body mass and blood transfusion was performed. Intense coughing and laryngospasm after extubation was recorded in 10 (6.4%) patients. Delayed awaking from anaesthesia result in 19 (12.2%) neonates in which the meningocele associated with hydrocephalus. Only two neonates required mechanical ventilation after anaesthesia, with duration no more than 24h.
Neonatal anaesthetic management in neural tube defects requires an understanding of the pharmacophysiologic limitations of the neonate as well as the pathophysiology of coexisting surgical disease.