IS ARNOLD CHIARI I AN ANESTHETIC CHALLENGE?
Portugal 
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7 slide(s) – English – 2011-09-08
Poster Title
“Is Arnold Chiari I an anesthetic challenge?”
Juliana L Cruz, M.D., Artur Vieira, M.D., Paulo J. Fragoso M.D., Tiago F Faria, M.D.
Anesthesiology, Hospital de Braga, Braga, Portugal, 4710 Braga.
Poster Abstract:
Background - Arnold-Chiari malformation Type I (ACM) is a congenital anomaly of downward displacement of the lowermost portion of the cerebellum with herniation of cerebellar tonsils through the foramen magnum. ACM normally presents in adolescents or adults with symptoms related to hydrocephalus or syringohydromyelia. Features include scoliosis, oculomotor disturbances, syncope, paraparesis, spasticity, respiratory failure, sleep disturbances, occipital dysplasia and torticollis.
Patients may have difficult airway and are at risk of neurologic deterioration during anesthesia induction.
Case report: A 63-year-old woman, ASA II, with ACM, hypertension and dyslipidemia was scheduled for hip replacement. The patient had Mallampati II score, but diminished cervical mobility. She presented no neurological symptoms.
Monitorization was according to ASA standards. Pre-medicated with Midazolam 2 mg iv. Induction was achieved with Fentanyl 0.2 mg, Propofol 150 mg, cisatracurium 6 mg iv, and maintenance with a mixture of Sevoflurane, oxygen and air. Orotracheal intubation was performed using videolaryngoscopy.
Surgery was performed without incidents. The patient was discharged to the surgical ward after 2 hours of uneventful stay in the post anesthesia care unit.
Discussion and conclusions:The challenge in the anesthetic management of ACM patients is to avoid intracanial or intra-spinal pressure variations and deal with possible airway difficulties.
In the present case, although no neurologic deficits were reported in the patient history, general anesthesia was chosen to avoid any spinal manipulation that could reduce intraspinal pressure.
We used videolaryngoscopy trying to accomplish two goals: overcome cervical spine diminished mobility; and lessen the sympathetic response to direct laryngoscopy.
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