An infant with hydrocephalus and lumbar meningomyelocele for ventriculoperitoneal shunt insertion: Concerns of an anesthesiologist

The anatomical and physiological differences in children make the administration of anesthesia difficult compared to the adults which is made more challenging when the child presents with a congenital anomaly. In this case, we report the anesthetic challenges presented by an 8-month-old baby born of full gestation with a lumbar swelling and hydrocephalus posted for ventriculoperitoneal shunt insertion. Magnetic resonance imaging scan revealed the presence of a large meningomyelocele with tethered sac and Arnold–Chiari malformation (Type 2). Anesthetic management included a thorough preoperative assessment of associated comorbidity, proper positioning, management of a difficult airway, prevention of any rise in intracranial pressure, and prevention of hypothermia. The perioperative period was uneventful, and the child recovered well.