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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2022; 09(03): 183-185
DOI: 10.1055/s-0042-1756429
Case Report

Awake Cranioplasty in a Patient with Rheumatic Heart Disease: A Novel Approach

Aparna Depuru 
1   Department of Anesthesia and Intensive Care, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Nidhi Bhatia 
1   Department of Anesthesia and Intensive Care, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Hemant Bhagat
1   Department of Anesthesia and Intensive Care, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Apinderpreet Singh
2   Department of Neurosurgery, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Cranioplasty is a surgical procedure that restores the normal anatomy following craniectomy. Restoring the skull bone ensures protection and normalizes the physiology as well as the cerebrospinal fluid dynamics. This surgical procedure usually requires administration of general anesthesia for retrieving the bone placed in the abdominal region and thereafter placing it in the cranium. We report the anesthetic management of a high-risk case who had severe mitral stenosis and was scheduled for cranioplasty. The anesthetic management of a patient with rheumatic heart disease, with severe mitral stenosis, posted for cranioplasty, is extremely challenging. The presence of cardiac pathology necessitates the need to balance patient's hemodynamics in accordance with the cardiac grid and tests the limits of the anesthesiologist's preparedness. We describe our experience of conduct of this case in regional anesthesia using scalp block on the defect site with an oblique transverse abdominis plane block for abdominal bone retrieval.

Keywords

awake cranioplasty - rheumatic heart disease - severe mitral stenosis - transverse abdominis plane block


Publication History

Article published online:
09 December 2022

© 2022. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sahoo SK, Kuanar D, Souvagya P. Effect of combination of scalp block and transversus abdominis plane block on postoperative quality of recovery after cranioplasty surgery: a prospective observational study. MedPulse International Journal of Anesthesiology 2019; 11 (03) 215-220
    CrossrefPubMedGoogle Scholar
  • 2 Syahril H, Gaus S, Arif SK, Wirawan NS. Awake cranioplasty: a case series. J Anesth Clin Res 2018; 9: 830
    CrossrefPubMedGoogle Scholar
  • 3 Paul A, Das S. Valvular heart disease and anaesthesia. Indian J Anaesth 2017; 61 (09) 721-727
    CrossrefPubMedGoogle Scholar
  • 4 Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience. Indian Heart J 2014; 66 (03) 320-326
    CrossrefPubMedGoogle Scholar
  • 5 Eagle KA, Chaitman BR, Fleishmann KE. et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for non-cardiac surgery: executive summary. Anesth Analg 2002; 94: 1052-1064
    PubMedGoogle Scholar
  • 6 Bando AA. Anaesthesia for neurosurgery. In: Barash PG, Cullen BF. eds. Clinical Anesthesia. Philadelphia: Lippincott-Raven; 1997: 699-746
    Google Scholar
  • 7 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143 (05) e35-e71
    CrossrefPubMedGoogle Scholar
  • 8 Jangra K, Rath GP. Anesthesia for awake craniotomy: what is new?. Curr Anesthesiol Rep 2018; 8: 318-327
    CrossrefPubMedGoogle Scholar
  • 9 Mukherjee A, Guhabiswas R, Kshirsagar S, Rupert E. Ultrasound guided oblique subcostal transversus abdominis plane block: an observational study on a new and promising analgesic technique. Indian J Anaesth 2016; 60 (04) 284-286
    CrossrefPubMedGoogle Scholar
  • 10 Liu X, Zhang K, Wang W, Xie G, Fang X. Dexmedetomidine sedation reduces atrial fibrillation after cardiac surgery compared to propofol: a randomized controlled trial. Crit Care 2016; 20 (01) 298
    CrossrefPubMedGoogle Scholar
  • 11 Chui J. Anesthesia for awake craniotomy: an update. Rev Colomb Anestesiol 2015; 43: 22-28
    PubMedGoogle Scholar
  • 12 Iirola T, Ihmsen H, Laitio R. et al. Population pharmacokinetics of dexmedetomidine during long-term sedation in intensive care patients. Br J Anaesth 2012; 108 (03) 460-468
    CrossrefPubMedGoogle Scholar