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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(03): 187-189
DOI: 10.1055/s-0038-1660691
Case Report
Indian Society of Neuroanaesthesiology and Critical Care

Sudden and Persistent Bradycardia: An Unexpected Indicator of Pin-Site Extradural Hematoma in a Pediatric Patient

Roneeta Nandi
1   Department of Anesthesiology and Pain, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Shruti Redhu
1   Department of Anesthesiology and Pain, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Rana Patir
2   Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Hari Hara Dash
1   Department of Anesthesiology and Pain, Fortis Memorial Research Institute, Gurugram, Haryana, India
› Author Affiliations Funding None.
Further Information

Publication History

Received: 27 April 2018

Accepted after revision: 14 May 2018

Publication Date:
26 June 2018 (online)

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Abstract

Depressed skull fracture and extradural hematoma are infrequent complications of skull pin fixation in children undergoing craniotomy. Neurosurgeons are often alerted about these complications by intraoperative brain swelling or postoperative neurological deterioration. We describe the development of pin-site extradural hematoma in a child on whom Mayfield skull clamp was applied during posterior fossa tumor excision. Sudden and persistent bradycardia observed by the anesthesiologist served as the sole warning sign. Such an on-table indicator of pin-site extradural hematoma has not been described earlier. The anesthesiologist must maintain vigilance and effective communication with surgical colleagues to ensure early detection and timely management of these pin-site complications.

Keywords

bradycardia - cranial fixation - depressed skull fracture - extradural hematoma - pediatric - pin-site complications - posterior fossa
 

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