Abstract

Introduction: Spina bifida is a major birth defect that is a result of failure of the neural tube to close in the developing fetus. It is associated with varying degrees of neurologic impairment. The anatomic level of the lesion generally correlates with the neurologic motor and sensory deficit and ranges from complete paralysis to minimal or no motor deficit. Case Report: A 3 year old male child who was diagnosed with spina bifida was posted for spina bifiida surgery. The patient had swelling in the lower back region associated with right lower limb weakness since birth. Patient developed continuous dribbling of urine. An MRI Lumbar spine was done which showed defect in the S1, S2, and S3 vertebrea with posterior herniation of spinal cord, neural placode and nerve roots which is suggestive of closed spinal dysarphism, spina bifida with lipo-myelocoele. After through pre anaesthetic check-up, patient was posted for surgery. Patient was intubated with 4.5mm portex uncuffed endo tracheal tube and patient was kept in prone position. Standard monitoring was ensured intra operatively. With a total blood loss of 150ml which is within the maximum allowable blood loss limit, and total of 600ml of IV fluids were given to prevent volume overload. Neurosurgeon wanted an awake test which was a challenge for us as patient was on uncuffed tube so, electromyography was used and TIVA with propofol was maintained to check after the corrective surgery. After the surgery patient was shifted to pediatric intensive care unit with ET tube in situ. Patient was extubated the following day. Conclusion: As the pediatric patient was posted for spina bifida surgery which is a major surgery which took around 6-7 hours. Blood loss, fluid status, pain post-operative hypoxia were of major concern. Amount of IV fluids to be given intra-operatively, maximum allowable blood loss were calculated prior to surgery. The anaesthetic management was successfully done here without any adverse events. Key Messages: Folic acid supplementation during pregnancy can prevent this defect that can happen as a congenital deficit and complications. Mortality and morbidity can be prevented with folic acid supplementation, early diagnosis or screening and early intervention. Our patient was a3 year old with deficits operated with planning with a with a multi disciplinary team and with a successful outcome.

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