Podcast
Questions and Answers
What is myelomeningocele classified as?
What is myelomeningocele classified as?
- A defect that does not involve any neural tissue.
- A congenital malformation that only affects the vertebral column.
- A herniated meningeal sac containing neural tissue. (correct)
- A type of spina bifida where the defect is covered with skin.
What characterizes spina bifida occulta?
What characterizes spina bifida occulta?
- It is associated with visible neural tissue at birth.
- The defect is covered with intact skin but may have underlying deformities. (correct)
- It always leads to immediate surgical intervention upon diagnosis.
- The defect occurs without any skin covering.
How is myelomeningocele typically diagnosed?
How is myelomeningocele typically diagnosed?
- Using ultrasonography in the prenatal period. (correct)
- By analyzing genetic markers postnatally.
- Through physical examination only after birth.
- Through MRI scans performed at the age of 2.
What is the recommended surgical intervention timeframe after birth for myelomeningocele?
What is the recommended surgical intervention timeframe after birth for myelomeningocele?
What condition is commonly associated with hydrocephalus in myelomeningocele cases?
What condition is commonly associated with hydrocephalus in myelomeningocele cases?
What is the prevalence rate of myelomeningocele?
What is the prevalence rate of myelomeningocele?
What is the definition of spina bifida cystic?
What is the definition of spina bifida cystic?
Which form of spina bifida contains a herniated meningeal sac without neural tissue?
Which form of spina bifida contains a herniated meningeal sac without neural tissue?
What should be considered for transfusion if the allowable blood loss is exceeded during surgery?
What should be considered for transfusion if the allowable blood loss is exceeded during surgery?
What is required for neonates with myelomeningocele regarding their surgical environment?
What is required for neonates with myelomeningocele regarding their surgical environment?
What is a common postoperative complication for patients with Arnold-Chiari malformation?
What is a common postoperative complication for patients with Arnold-Chiari malformation?
Children with which condition may require tracheostomy and gastrostomy?
Children with which condition may require tracheostomy and gastrostomy?
What may occur in the postoperative period after a tight skin closure?
What may occur in the postoperative period after a tight skin closure?
What should be replaced to prevent insensible fluid loss during surgery?
What should be replaced to prevent insensible fluid loss during surgery?
What potential effect does extreme head flexion have on children regarding health outcomes?
What potential effect does extreme head flexion have on children regarding health outcomes?
What dietary sensitivity might children with a latex allergy exhibit?
What dietary sensitivity might children with a latex allergy exhibit?
What is the initial surgical procedure often required for patients with Type II Chiari malformation?
What is the initial surgical procedure often required for patients with Type II Chiari malformation?
Why are neonates with myelodysplasia at high risk for developing latex allergy?
Why are neonates with myelodysplasia at high risk for developing latex allergy?
What is a critical consideration for the operating room before the arrival of the patient?
What is a critical consideration for the operating room before the arrival of the patient?
Which position is generally preferred for tracheal intubation in infants with small defects?
Which position is generally preferred for tracheal intubation in infants with small defects?
What type of muscle relaxant is generally contraindicated during maintenance of anesthesia?
What type of muscle relaxant is generally contraindicated during maintenance of anesthesia?
In neonates with myelomeningocele, confirmation of endotracheal tube position is critical due to the potential for what anatomical issue?
In neonates with myelomeningocele, confirmation of endotracheal tube position is critical due to the potential for what anatomical issue?
What is indicated for patients with significant loss from a skin defect during surgical repair?
What is indicated for patients with significant loss from a skin defect during surgical repair?
How should infused fluids be managed during the surgical procedure?
How should infused fluids be managed during the surgical procedure?
What should be done prior to administering succinylcholine during intubation in neonates?
What should be done prior to administering succinylcholine during intubation in neonates?
Which anesthetic agents are acceptable for use during induction and maintenance?
Which anesthetic agents are acceptable for use during induction and maintenance?
Study Notes
Introduction to Myelomeningocele
- Myelodysplasia, commonly known as spina bifida, involves congenital malformations of midline back structures, affecting skin, vertebral bones, and neural elements.
- Occurs primarily at the lumbar level, but may arise at any vertebral level.
- Classified into two main types based on skin coverage:
- Spina Bifida Cystic: Defect without skin covering, evident at birth.
- Spina Bifida Occulta: Covered by intact skin, potentially masking the defect until later detection.
Types of Spina Bifida Cystic
- Divided into:
- Meningocele: Meningeal sac herniates through the defect but contains no neural tissue.
- Myelomeningocele: Contains neural tissue, representing the most common congenital central nervous system defect, approximately 4 cases per 10,000 live births.
Diagnosis
- Prenatal diagnosis typically performed via ultrasonography.
Anesthetic Considerations
Preoperative
- Urgent surgical intervention necessary within 24 hours post-birth to prevent neural damage and infection due to exposed structures.
- Hydrocephalus often linked with type II Chiari malformation; requires ventricular shunt placement.
- Latex allergy risk must be acknowledged; avoidance of latex products starts at birth.
- Preoperative evaluation includes monitoring neurological deficits and assessing defect size for surgical planning.
- Routine preoperative tests: hemoglobin level and type & screen. Ensure availability of packed red blood cells (PRBCs) for surgery.
Intraoperative
- High risk of hypothermia due to large exposed area; maintain a warm operating environment.
- Anesthesia induction positioning challenges arise from defect size.
- Standard monitoring and acceptable anesthetic agents used; succinylcholine should be preceded by atropine due to bradycardia risk.
- Non-depolarizing muscle relaxants may be used, ensuring reversal before surgery for nerve monitoring.
- Difficult airways should be anticipated given head and trachea anomalies; extubation strategy planned.
Postoperative Care
- Close monitoring of respiratory function needed post-surgery due to tight closures potentially impacting breathing.
- Schedule VP shunt placement for hydrocephalus treatment as necessary.
Long-Term Outcomes
- Associated conditions include macrocephaly, vocal cord paralysis, and cranial nerve dysfunction manifesting in various complications.
- Risk of chronic aspiration may necessitate tracheostomy and gastrostomy in severe cases.
- Children may experience abnormal reactions to hypoxia and hypercarbia due to central nervous system issues.
- Neurological deficits may persist, affecting bowel and bladder function and lower extremity mobility based on defect level.
- Individuals with lesions above L4 commonly experience paraplegia; lower levels may allow ambulation.
- Latex allergies can influence reactions to certain foods and medications.
- Intrauterine surgery experimented to mitigate myelodysplasia damage is practiced in select U.S. centers.
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Description
This quiz explores the topic of myelomeningocele, a form of spina bifida that involves congenital malformations of the spinal column. It delves into its classifications, implications, and locations along the vertebral column. Gain insights into this condition and its effects on affected individuals.
