PDF(Pubmed)
Abstract：
This case report delves into the anesthesia management in a 23-year-old male with complications of meningomyelocele, a catastrophic congenital neural tube defect. The patient, paraplegic since birth with severe scoliosis, presented with a femoral fracture, prompting the need for careful consideration of anesthesia strategies. The challenges included counseling the family on the risks and benefits of surgery under general anesthesia, selecting an appropriate anesthetic plan for an anticipated difficult airway, and addressing ventilation strategies for restrictive lung disease. To tackle the anticipated difficult airway, an awake pediatric fiberoptic bronchoscopy was performed in the recovery room, facilitating a conscious sedation approach. In the operating room, monitored anesthesia care with dexmedetomidine infusion was employed, complemented by careful positioning and padding in the lateral position. The awake fiberoptic checkscopy proved crucial in avoiding unnecessary general anesthesia. A patient-centered approach contributed to the successful execution of a complex anesthesia plan, ensuring optimal care for this unique patient population.
摘要：
该病例报告探讨了一名23岁男性患有脑膜脊髓膨出并发症的麻醉管理，灾难性的先天性神经管缺陷.病人,自出生以来截瘫严重脊柱侧凸，表现为股骨骨折，提示需要仔细考虑麻醉策略。挑战包括就全身麻醉下手术的风险和收益向家人提供咨询，为预期的困难气道选择适当的麻醉方案，以及限制性肺病的通气策略。为了解决预期的困难气道，在康复室进行了清醒的小儿纤维支气管镜检查，促进有意识的镇静方法。在手术室里,采用右美托咪定输注的监测麻醉护理，辅以仔细的定位和填充在横向位置。清醒的光纤检查对于避免不必要的全身麻醉至关重要。以患者为中心的方法有助于成功执行复杂的麻醉计划，确保为这个独特的患者群体提供最佳护理。
