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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

Authors

  • 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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