Paediatric Neuroanaesthesia, Craniospinal Dysraphism and Hydrocephalus — WACS Viva & Clinical Scenarios (Paediatrics & Day Care)

Exam-style paediatric neuroanaesthesia, craniospinal dysraphism and hydrocephalus viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 2-day-old neonate weighing 2.9 kg presents with a large, ruptured lumbosacral myelomeningocele weeping CSF. The infant is scheduled for emergency surgical closure. The anterior fontanelle is full. Outline your anaesthetic plan from positioning for induction, airway management, temperature control, latex avoidance, intraoperative blood and fluid replacement, to emergence.
• SCENARIO 2: A 3-month-old infant with a giant occipital encephalocele larger than the child's head is brought to theatre for surgical excision and dural closure. Detail your approach to airway management, patient positioning to avoid sac rupture, maintenance of cerebral perfusion, and intraoperative fluid and blood management.
• SCENARIO 3: A 5-year-old child presents with morning headaches, persistent vomiting, ataxia, and papilloedema, diagnosed with a cystic posterior fossa medulloblastoma. The surgery is planned in the prone position. Discuss your anaesthetic induction strategy to prevent acute coning, positioning considerations, intraoperative neuro-monitoring, and management of intraoperative bradycardia or venous air embolism.
• SCENARIO 4: An 8-month-old infant weighing 8 kg is scheduled for fronto-orbital advancement and cranial vault reconstruction for coronal craniosynostosis. Explain your preoperative haematological preparation, intraoperative blood conservation strategies (including tranexamic acid protocols), vascular access, and management of sudden massive venous sinus haemorrhage.