Anaesthetic management of a case of idiopathic intracranial hypertension
A 45-year-old female, weighing 70 kg presented with complaints of headache, menorrhagia and pain in the abdomen was admitted to our hospital. She was posted for transcervical resection of the endometrium and patient had a past history of headache and blurring of vision 2 years ago and was diagnosed to have IIH and was on tablet acetazolamide 250 mg every 6 h. She had a history of lumbar CSF drainage twice. Patient had a history of hypertension and was on tablet atenolol once daily. On pre-operative examination, pulse was 70/min and blood pressure was under control. Other general and systemic examination was normal. All other investigations were within normal limits. Computer tomography brain was normal and magnetic resonance imaging revealed partially empty sella and no pituitary mass lesion, cerebral hemisphere and ventricles were normal. Fundus examination revealed chronic papilledema, optic nerve pallor and perimetry showed increased size of blind spot. Neurologist advised preoperative CSF pressure measurement and drainage if pressure is high. CSF manometry was performed in the lateral decubitus position and CSF pressure was more than 250 mm H2O with normal cytological and biochemical profile. 20 mL of CSF was drained with a 22 gauge Quincke's needle. After drainage the CSF pressure was 150 mm H2O. Patient was posted for surgery after 2 days.\nOn the day of surgery, injection glycopyrrolate (0.2 mg), injection midazolam (2 mg) and injection fentanyl (200 μg) were given intravenously as pre-medication. Anaesthesia was induced with propofol 175 mg and tracheal intubation was facilitated with vecuronium 5 mg injection plain lignocaine 2% 5 ml was given to attenuate pressor response. Anaesthesia was maintained with oxygen, nitrous oxide, propofol infusion, and vecuronium. Intra-operatively injection mannitol 1 g/kg was given. Monitoring included pulse oximetry, electrocardiogram (ECG), noninvasive blood pressure noninvasive blood pressure (NIBP), ETCO2, urine out-put and temperature. At the end of surgery neuro-muscular block was reversed with injection neostigmine 3.5 mg and glycopyrrolate 0.4 mg. She was shifted to post-operative recovery room and monitored for 48 h with pulse oximetry, ECG, NIBP, urine out-put, and temperature. She was completely asymptomatic at discharge.