Rest

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MY neuro call yesterday became purely paediatric anaesthesia !! Obviously i can;t handle these cases alone so i called on my specialist on call to be there with me ! haks.. Well , its part regulation partly.. i;ve not done paediatrics anaesthesia as a rotation yet !!

My first case was a ONE DAY OLD boy.. 3.1kg and born at term. He had myelomenigocoele ( lower spine not well closed ) with hydrocephalus ( oversize head filled with fluid )* the easiest explanation i can suggest !! . The neurosurgeons were planning for an OMAYA shunt and closing the defect on his back. Honestly , the procedure was short , but preparing the baby for anaesthesia was longer !! We had to ensure good lines , good heat control , drugs well calculated.. macam-macamlah !!! haks.. thats always the case for babies i reckon ; coz a slight , small mistake makes a lot of difference !! The baby lost 50ml of blood and he became really PALE !! an as expected , when the op was done , baby became apneic ( not breathing ). So we had to let the tube remain in there and sent him to SCN.

Next was a 3 month old baby ; revision of her VP shunt. Again , boss was there to help.Intubation was a bit tricky , her tongue was enlarged therefore i had to manipulate my laryngoscope to visualize her vocal chord. Otherwise , the op was uneventful.However , post extubation the baby did not maintain her oxygenation... desaturated. Boss was panicky and took over to reintubate the baby !! However , she failed.. haks !! it must have been the tongue !! She inserted the small LMA , alhamdulillah her SPO2 returned to normal and it took quite a while before she maintained a good respiratory pattern. I knew that things may go wrong when extubating as i was not keen to do it but boss insisted !!! It must have been hypothermia causing the problem. We manage to send her back to the ward afterwards..

Then , a 6 year old boy who just had an op done to remove his teratoma. Apparently , his shunt was leaky and you can see the collection behind his head. He was a sweet and cute boy. He was very co-operative when i asked him to recite bismillah and alfatihah before i start.Somehow , you feel pity for them ; having to undergo operation after operation to improve his condition. It is quite unfortunate that he had lost his eyesight which was permanent. His op went well and his extubation was smooth. I pray to god that he would be ok ; not just for this op but with his life undertaking.It must have been a traumatic period for his parents.

Well , i was knackered after this three op !! Belum yg lain-lain tu.. Each Op took an average of 3 hours ! PAediatrics is more taxing as i had my eyes glued on the monitoring screen from the word start ! They are so fragile and doing Neurosurgery is very tricky as one needs to optimize all for a smooth operation and recovery.

It was malam jumaat kot , so the mat rempits may have decide to stay at home or do tarawikh !! There was no craniectomy till morning and ... it was a good call.