Abstract
Cranioplasty is a surgical procedure that restores the normal anatomy following craniectomy.
Restoring the skull bone ensures protection and normalizes the physiology as well
as the cerebrospinal fluid dynamics. This surgical procedure usually requires administration
of general anesthesia for retrieving the bone placed in the abdominal region and thereafter
placing it in the cranium. We report the anesthetic management of a high-risk case
who had severe mitral stenosis and was scheduled for cranioplasty. The anesthetic
management of a patient with rheumatic heart disease, with severe mitral stenosis,
posted for cranioplasty, is extremely challenging. The presence of cardiac pathology
necessitates the need to balance patient's hemodynamics in accordance with the cardiac
grid and tests the limits of the anesthesiologist's preparedness. We describe our
experience of conduct of this case in regional anesthesia using scalp block on the
defect site with an oblique transverse abdominis plane block for abdominal bone retrieval.
Keywords
awake cranioplasty - rheumatic heart disease - severe mitral stenosis - transverse
abdominis plane block
