# Overcoming Airway Hurdles: A Case Report of Anesthetic Challenges in Meningomyelocele Complications

## TL;DR

This case report discusses the challenges of administering anesthesia to a patient with meningomyelocele complications and highlights a successful patient-centered approach.

## Contribution

The report introduces a successful anesthetic strategy using awake fiberoptic bronchoscopy and monitored anesthesia care for a patient with a difficult airway.

## Key findings

- Awake pediatric fiberoptic bronchoscopy was effectively used to manage an anticipated difficult airway.
- Monitored anesthesia care with dexmedetomidine infusion was successfully employed in the operating room.
- A patient-centered approach ensured optimal care for a complex case involving meningomyelocele complications.

## Abstract

This case report delves into the anesthesia management in a 23-year-old male with complications of meningomyelocele, a catastrophic congenital neural tube defect. The patient, paraplegic since birth with severe scoliosis, presented with a femoral fracture, prompting the need for careful consideration of anesthesia strategies. The challenges included counseling the family on the risks and benefits of surgery under general anesthesia, selecting an appropriate anesthetic plan for an anticipated difficult airway, and addressing ventilation strategies for restrictive lung disease. To tackle the anticipated difficult airway, an awake pediatric fiberoptic bronchoscopy was performed in the recovery room, facilitating a conscious sedation approach. In the operating room, monitored anesthesia care with dexmedetomidine infusion was employed, complemented by careful positioning and padding in the lateral position. The awake fiberoptic checkscopy proved crucial in avoiding unnecessary general anesthesia. A patient-centered approach contributed to the successful execution of a complex anesthesia plan, ensuring optimal care for this unique patient population.