|LETTERS TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 55-56
Customized doughnut with foam cushion: Facilitates laryngoscopy position for neonate with occipital encephalocele
Shriaunsh R Abhade, Sushama Raghunath Tandale, Sanyogita V Naik, Madhu A Chavan
Department of Anaesthesia, BJGMC and SGH, Pune, Maharashtra, India
|Date of Web Publication||6-May-2019|
Dr. Sushama Raghunath Tandale
Department of Anaesthesia, BJGMC and SGH, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Abhade SR, Tandale SR, Naik SV, Chavan MA. Customized doughnut with foam cushion: Facilitates laryngoscopy position for neonate with occipital encephalocele. Indian Anaesth Forum 2019;20:55-6
|How to cite this URL:|
Abhade SR, Tandale SR, Naik SV, Chavan MA. Customized doughnut with foam cushion: Facilitates laryngoscopy position for neonate with occipital encephalocele. Indian Anaesth Forum [serial online] 2019 [cited 2019 Aug 26];20:55-6. Available from: http://www.theiaforum.org/text.asp?2019/20/1/55/257687
A 16-day-old, full-term neonate, weighing 2.8 kg was referred to our institute for excision of huge occipital encephalocele. The physical examination of neonate was unremarkable except for microcephaly and huge pedunculated cystic swelling measuring 13 cm × 8.5 cm × 5 cm, arising from the occipital region with skin ulceration. Spontaneous limb movements were present in all the four limbs. There was no other associated congenital malformation. Hematological and biochemical investigations of the patients were unremarkable. The neonate was lying in lateral position due to huge swelling. We prepared a doughnut made up from roller bandage, after taking the measurement of swelling in such a way that swelling should lie within the doughnut space with 1 cm free margin from all sides. The depth of doughnut space was also kept more than measured value, so as to accommodate the head and swelling during neck extension without any undue pressure over swelling [Figure 1]a. Floor and side walls of doughnut were covered by cotton for cushioning effect. Doughnut was placed above the foam cushion on operating room table. Foam cushion was of the same height as of doughnut. Neonate's head along with cystic swelling was placed over doughnut, and remaining part of the body was placed over foam cushion. This arrangement made the neonate to lie in the supine position with neck extension. The standard anesthesia monitors were used. Difficult airway cart was kept ready. Neonate was premedicated with intravenous glycopyrrolate 15 μg. After preoxygenation, the anesthetic plane was deepened with gradually increasing sevoflurane concentration up to 8 volume percentage with 100% oxygen through Jackson Rees Circuit. Gentle laryngoscopy was performed with miller size 0 blade, and Cormack–Lehane Grade II was observed followed by endotracheal intubation with 3.0 uncuffed tube [Figure 1]b. The surgery was uneventful with minimal blood loss. At the completion of surgery, the neuromuscular block was reversed, and the trachea was extubated. The neonate was shifted to intensive care unit for further management.
|Figure 1: (a) Neonate having huge occipital encephalocele. (b) Neonate placed in supine position with customized doughnut and foam cushion|
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Encephalocele is a neural tube defect where meninges and brain tissue protrudes out through a bony defect on the skull. Occipital encephalocele is a common presentation. Incidence is 1 in 5000 live births. Early excision is recommended to prevent rupture and infection. Associated congenital anomalies are club foot, hydrocephalus and Arnold Chiari malformation More Details, exstrophy of bladder, prolapsed uterus, Klippel Feil syndrome, and cardiac defects. Apart from difficult positioning for laryngoscopy, other intraoperative concerns are prone positioning, hemodynamic disturbances, and difficulty in assessing blood loss.
Proper positioning of neonate is essential for laryngoscopy as the presence of huge occipital encephalocele and restricted neck movement makes it difficult. Inadequate positioning may lead to frequent attempts to intubation, possible airway trauma, rise in intracranial pressure, and rupture of encephalocele. Our method of positioning neonate over customized doughnut and foam cushion offers certain advantages such as it is inexpensive as it can be made up of easily available resources, neonate can be placed in supine position with neck extension for mask ventilation and laryngoscopy, neck manipulations are possible in doughnut space without any pressure on sac and requires very less workforce for airway management.
Alternative options include intubation in a lateral position which requires expertise, placing the neonate's head beyond the edge of the table, which requires help from additional workforce and gradual decompression of encephalocele sac under sterile conditions.,
We wish to highlight the importance of customized doughnut made up from roller bandage, and foam cushion for supine positioning of neonates with huge occipital encephalocele with successful airway management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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