Navigating the anesthetic challenges for craniotomy in infant with bilateral subdural empyema: A case report
Abstract
Subdural empyema (SDE) is a critical intracranial infection requiring urgent surgical intervention. Anesthetic management in infants with SDE involves challenges such as elevated intracranial pressure (ICP), seizures, and hemodynamic instability. Effective management, including careful monitoring and appropriate anesthesia technique, is essential to improve outcomes and reduce the complications.
A 3-months-old male infant, 6 kg, was admitted with recurrent fever and seizures, accompanied by a history of thrombocytopenia. Neuroimaging revealed extensive subdural empyema, prompting urgent craniotomy for empyema evacuation. General anesthesia was successfully administered, maintaining hemodynamic stability throughout the procedure. Patient’s clinical condition was significantly improved and extubated on the next day, then was transferred to the pediatric ward for continued care.
Preoperative management of an infant with subdural empyema and elevated ICP, focuses on reducing ICP, managing seizures, stabilizing hemodynamics and addressing infection. A Total Intravenous Anesthesia (TIVA) based approach, combined with fluid and ventilation management and neuroprotective agents ensure stable perioperative conditions and support recovery. Postoperatively, a multidisciplinary approach involving neurological monitoring, seizure prophylaxis with midazolam, and antimicrobial therapy was implemented to optimize recovery, control ICP, and prevent complications. This comprehensive management strategy aims to prevent secondary brain injury and promotes a stable recovery.
Abbreviations: CPP: Cerebral perfusion pressure, DBP: Diastolic blood pressure, EtCO2: End tidal CO2, ETT: endotracheal tube, HR: Heart Rate, ICP: intracranial pressure, pGCS: pediatric Glasgow Coma Scale, SBP: Systolic blood pressure, SDE: Subdural empyema, SpO2: Venous capillary oxygen saturation; Temp: Temperature, TIVA: Total Intravenous Anesthesia
Keyword: anesthesia; craniotomy; ICP; infant; subdural empyema; TIVA
Citation: Nugroho A, Bisri DY, Rachman IA. Navigating the anesthetic challenges for craniotomy in infant with bilateral subdural empyema: A case report. Anaesth. pain intensive care 2025;29(3):715-719.
Received: March 10, 2025; Revised: March 22, 2025; Accepted: March 22, 2025
