Title: Neonatal Airway Management in Occipital Encephalocele
Abstract: To the Editor: A 1.75 kg 2-day-old baby presented for repair of a large occipital encephalocele. One goal of the anesthetic was to not rupture the encephalocele. The occipital encephalocele (10 × 8 cm) made supine position of the head impossible and limited neck extension [Figure 1].Figure 1.: An 8 × 10 cm occipital encephalocele (8 × 10 cm), complicating airway management.We positioned the child in a lateral position (1) and induced anesthesia with halothane in 100% oxygen by mask. Two attempts of direct laryngoscopy (Miller blade size 0) in the lateral position showed only the tip of the epiglottis (Cormack-Lehane Grade 3), and we could not intubate the child with this limited view. We lifted the baby off the table with the help of two assistants. One assistant stabilized the child’s head and shoulders, and the other supported the torso, pelvis, and lower limbs. Laryngoscopy in this position improved visualization (Cormack-Lehane Grade 2). We intubated the trachea with a 3-mm uncuffed, endotracheal tube, and proceeded uneventfully. Alternative approaches include placing the child in the supine position on a platform of rolled-up blankets (2), placing the child’s head beyond the edge of the table with an assistant supporting it (3), or needle decompression of the encephalocele sac under sterile conditions (3). Yogesh Manhas, MD Department of Anaesthesia Morababad Charitable Trust and Health Research Centre Morababad, India Nevin Kollannoor Chinnan, MD, DNB Department of Anesthesia and Intensive Care Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, India Amrit Kumar Singh, MS MCh Department of Neurosurgery Morababad Charitable Trust and Health Research Centre Moradabad, India