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Challenges of anaesthetising a child with Bow Hunter’s syndrome and dilated cardiomyopathy for occipitocervical fusion
  1. Lalrinhlui Renthlei1,
  2. Ramamani Mariappan2,
  3. Krishnaprabhu Raju3 and
  4. Jeena Joseph3
  1. 1Department of Anaesthesia, Christian Medical College, Vellore, Tamilnadu, India
  2. 2Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
  3. 3Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India
  1. Correspondence to Dr Ramamani Mariappan; ramamani{at}cmcvellore.ac.in

Abstract

Paediatric Bow Hunter’s syndrome (BHS), or rotational vertebral artery syndrome, is a rare cause of posterior circulation insufficiency in children. It results from mechanical obstruction of the vertebral artery by the transverse process of cervical vertebrae resulting in vertebrobasilar insufficiency during the neck rotation to the sides. Paediatric dilated cardiomyopathy (DCM) is a rare myocardial disease that presents with ventricular dilatation and cardiac dysfunction. This case report describes the successful anaesthetic management of an boy with BHS due to atlantoaxial dislocation and DCM. The child was anaesthetised by keeping the following anaesthetic goals in mind such as maintenance of the heart rate, rhythm, preload, afterload and contractility close to the baseline for both DCM and BHS. Haemodynamic management with optimal fluids, inotrope and a vasopressor and titrating its volume and doses using multimodal haemodynamic monitoring while keeping both cardio and neuroprotective strategies, and the multimodal analgesia techniques helped the child for faster recovery.

  • Neuroanaesthesia
  • Heart failure
  • Paediatrics
  • Neurosurgery

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Footnotes

  • Contributors LR: involved with perioperative management, preparation of manuscript and revising the manuscript. RM: involved with perioperative management, preparation of manuscript and revising the manuscript. KP: involved with perioperative management, revising the manuscript. JJ: involved with perioperative management, revising the manuscript. All authors revised the final draft and approved it for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.