Scalp block for drainage of cerebral abscess in a patient with tetralogy of fallot

Background: Tetralogy of fallot (TOF) is the most common cyanotic congenital heart defect. Such patients are prone to frequent brain abscesses and account for 13–70% of all brain abscesses. The anaesthetic concerns in such patients are to maintain the systemic vascular resistance, reduce the pulmonary vascular resistance and prevent hyper cyanotic episodes intra-operatively. Case Summary: A 21-year-old male was admitted in the Department of Neurosurgery at Sir JJ Group of Hospitals, Mumbai with chief complains of headache, vomiting since 2 months and multiple episodes of abnormal body movements since 2 days. The patient was a known case of TOF. On examination, the patient was conscious, oriented with a Glasgow coma scale of 15/15 and was vitally stable with central cyanosis, clubbing and a pan-systolic murmur. Doppler was suggestive of a ventricular septal defect of size 0.7 cm with left to right flow. Computed tomography brain revealed a large space occupying lesion (approxmately 4.2 cm × 5.4 cm × 5.9 cm in size) in left temporal and left parietal region with a midline shift of approximately 13 mm toward right.

The patient was taken in the operation theatre, an 18-gauge intravenous line and appropriate monitors were attached. The patient was given a prophylactic dose of antibiotic, was pre-medicated with injection glycopyrollate, injection ondansetron, injection midazolam with 100% oxygen, was sedated using injection fentanyl and injection ketamine. After confirming adequate analgesia scalp block was given. Anaesthesia was maintained with injection fentanyl and 100% O₂ via oxygen mask.

Conclusion: Intravenous sedation along with scalp block resulted in a good outcome for this patient, thereby avoiding general anaesthesia and its side effects.

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