Title: Anaesthetic Considerations in Neurofibromatosis Complicated with Kyphoscoliosis and Restrictive Lung Disease

Authors: Dr Harpreet Kaur, Dr Harkomal Kaur, Dr M. Magila

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.175

Abstract

Neurofibromatosis is a genetically transmitted disease arising from the nervous tissue. It is associated with widespread systemic manifestations that pose a challenging situation to the anaesthesiologist. Kyphoscoliosis is one of the musculoskeletal anomalies that present in 10% of patients with neurofibromatosis I. The present case discusses the anaesthetic considerations of a known case of NF I with associated kyphoscoliosis who was posted for surgical removal of mass from the right iliac crest and thigh under spinal anaesthesia. A thorough pre anaesthetic evaluation and workup turn out to be the cornerstone in management of such cases.

Keywords: neurofibromatosis I, plexiform neurofibroma, scoliosis, respiratory system, anaesthesia, spinal, kyphosis.

References

1.      Hirsch NP, Murphy A, Radcliffe JJ. Neurofibromatosis: clinical presentations and anaesthetic implications. Br J Anaesth 2001; 86: 555-64.

2.      Akbarnia BA, Gabriel KR, Beckman E, Chalk D. Prevalence of scoliosis in neurofibromatosis. Spine 1992;17: S244-8.

3.      Heriot AG, Wells FC. An unusual case of flail chest: surgical repair using Marlex mesh. Thorax. 1997; 52: 488-9.

4.      Cooper DM, Rojas JV, Mellins RB. Respiratory mechanics in adolescents with idiopathic scoliosis. Am Rev Respir Dis 1984; 130: 16-22.

5.      Raw DA, Beattie JK, Hunter JM. Review article: Anaesthesia for spinal surgery in adults. Br J Anaesth 2003; 91: 886-904.

6.      Kulkarni AH, Ambareesha M. Scoliosis and anaesthetic considerations. Indian J Anaesth 2007; 51: 486-95.

7.      Ozyurt G, Basagan-Mogol E, Bilgin H,Tokat O. Spinal anaesthesia in a patient with severe thoracolumbar kyphoscoliosis. Tokuhu J Exp Med.2005; 207(3): 239-42.

8.      Kleinman W, Mikhail M. Spinal, epidural and caudal blocks in: Morgan GE, Mikhail SM, Murray MJ, eds. Clinical Anaesthesiology .4th ed. New York: Mc Graw Hill Inc; 2006; 289-323.

9.      Holmstrom E, Laugaland K, Rawal N, Haliberg S. Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery. Can J Anaesth 1993; 10(7): 601-6.

10.  White AA, Panjabi MM. Clinical biomechanics of the spine 2nd ed. Philadelphia:Lippincott, 1990.

11.  Peelle MW, Luhmann SJ. Management of adolescent idiopathic scoliosis. Neurosurg Clin N Am 2007; 18: 575-83.

12.  Koumbourlis AC. Review: Scoliosis and the respiratory sys­tem. Paed Resp Rev 2006; 7:152-160. 

13.  Atallah MM, Demian AD, Shorrab AA. Development of a difficulty score for spinal anaesthesia, Br J Anaesth 2004;92: 354-60

14.  de Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study, Eur J Anaesthesiol 2002;19 :447-51.

15.  C. Bowens, K. H. Dobie, C. J. Devin, J. M. Corey; An approach to neuraxial anaesthesia for the severely scoliotic spine. Br J Anaesth 2013; 111 (5): 807-11.

Corresponding Author

Dr Harkomal Kaur

House No. 328, Akash Avenue, FGC road, Amritsar 143001, Punjab, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.