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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4417.30

Abstract

Aims: To indentify airway abnormalities, autonomic nervous system dysfunction (ANSD) and postoperative respiratory complications in patients with craniovertebral junction (CVJ) anomalies with Arnold Chiari Malformation( ACM) for safe and better anaesthetic management. Method: Forty Three patients with CVJ anomalies with ACM were evaluated and operated under general anaesthesia. Result Out of 43 patients of CVJ anomalies with ACM, 29 patients had type I ACM and 14 patients had type II ACM. Vocal cord involvement was seen in three patients in type II. One patient had bilateral vocal cord paralysis (VCP), requiring tracheostomy preoperatively and one had unilateral (left) vocal cord paralysis and another one patient had bilateral vocal cord paresis. Both were planned for awake fiberoptic intubation. Overall vocal cord involvement was 6.9% with 21.42% in type II ACM. No patients had vocal cord involvement in type I ACM. In type II ACM patients, out of eight sleep apnoea patients, three had sleep apnoea with vocal cord involvement and remaining five had sleep apnoea only. Out of those five patients, three patients had difficult intubation. One patient had post operative respiratory failure requiring ventilator support for two days. Sleep apnoea was seen in 18.6% patients. All patients were belonging to type II ACM with 57.14% incidence. Syringomyelia was found in six patients with four in type I and two in type II ACM. Incidence of syringomyelia in all ACM patients was 13.95 % with 6.89% in type II and 28.5% in type I ACM. Three patients had hydrocephalus in type II ACM. Five patients with cervical collor were planned for awake fiberoptic intubation. Coclusion: Preoperative detection of airway abnormality, autonomic nervous system dysfunction , airway security using fiberoptic intubation and post operative airway protection are required for safe anaesthetic management of these patients with CVJ anomalies with ACM.

Keywords : Airway; Anesthesia; CVJ Anomalies; Arnold- Chiari Malformation. 

Corresponding Author : Dipika P. Patel, Associate Professor, Department of Anaesthesiology, Gujarat Cancer and Reaserch Institute, B.J.Medical College, Civil hospital, Ahmedabad, Gujarat 380016, India.