Anesthetic Considerations in Pediatric Corneal Neurotization: A Case Report

TL;DR

This case report discusses anesthetic strategies for a six-year-old child undergoing corneal neurotization surgery to treat congenital corneal anesthesia.

Contribution

The paper provides a detailed account of anesthetic management in a rare pediatric corneal neurotization case.

Findings

Anesthetic care focused on anxiety reduction, airway safety, and multimodal analgesia.

The procedure was uneventful with stable hemodynamics and effective postoperative pain control.

Tailored anesthetic strategies are crucial for pediatric neurotization procedures.

Abstract

Congenital corneal anesthesia (CCA) is a rare pediatric disorder characterized by absent or markedly reduced corneal sensation, predisposing to neurotrophic keratopathy and vision-threatening complications. Corneal neurotization has emerged as a surgical option to restore corneal innervation, but anesthetic considerations in pediatric cases remain scarcely reported. We present the anesthetic management of a six-year-old female child with CCA and recurrent herpetic keratitis following deep anterior lamellar keratoplasty, who underwent indirect corneal neurotization with a sural nerve graft. Anesthetic care focused on preoperative anxiety reduction, airway safety, multimodal analgesia, and limited neuromuscular blockade to facilitate intraoperative neuromonitoring. Standard monitoring included electrocardiography, non-invasive blood pressure, pulse oximetry, capnography, temperature, and ulnar nerve twitch assessment. Perioperative antiviral prophylaxis (oral acyclovir) was maintained, and ondansetron was administered for PONV prophylaxis. The four-hour procedure was uneventful, with stable hemodynamics and adequate postoperative pain control. Pain was assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) scale, which remained at a level of <3/10 throughout the first 24 hours. This report highlights the importance of tailored anesthetic strategies in pediatric neurotization procedures, balancing surgical requirements with age-specific physiological considerations.

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