A 40-year-old woman is booked on your list tomorrow for posterior fossa craniotomy and resection of medulloblastoma. She presents with a three-week history of worsening headache, ataxia and dysarthria.
She has a medical history of mild intellectual impairment, obesity (BMI 35) and an unrepaired Ebstein's congenital cardiac anomaly.
The last cardiology review that is recorded in the hospital medical record was ten years ago and revealed the following:
Moderate tricuspid regurgitation (posterior and septal leaflets adherent)
Some right ventricular enlargement
Atrial septal defect
No evidence of tachyarrhythmias
The neurosurgeon wishes to perform the surgery with the patient prone with reverse Trendelenberg (head-up) positioning. A sagittal image of the patient's brain MRI is displayed.
Sections covered in this viva
Assessment prior to posterior fossa craniotomy in a patient with congenital cardiac disease and intellectual impairmentAnaesthetic planning for posterior fossa craniotomy. Recognition and treatment of venous air embolismManagement of post-craniotomy bleeding in recovery with associated atrial fibrillation