R ocular surgery – transfer of eye muscles and eye botox for CN palsy 

Background: 

• Medullary Cavernoma
  • Recurrent Intracranial haemorrhage 
  • Multiple ICU admissions 
• Lone living – independent ADL’s 
  • Home supports 
• DASI 5 MET’s 

Issues: 

• LMN Facial Nerve palsy – forehead involvement
  • PEG in situ – can now tolerate a normal diet with no choking, or aspiration 
• Hoarse voice with pronounced dysphonia o Aetiology uncertain – trauma from ICU stay/repeated intubation 
  • Manifestation of cranial bleed? 
  • Previous grade 1 intubation – no record of trauma/difficulty 
  • No red flag symptoms – no dyspnoea, can lie flat, 
  • Vocal changes have been consistent since hospital admission. No deterioration 
  • Nasendoscopy – unilateral VC paralysis 
• Complex central sleep apnoea – uses CPAP 

Discussion: 

• Airway plan – ETT vs LMA
  • Unlikely to be suitable to for LMA 
  • Often lengthy 
  • May require muscle relaxation to facilitate muscle transfer 
• Surgical complexity – unknown.
  • Booked as day procedure 
  • Need to liaise with surgical team 

Plan:

• Discuss with surgeon 
• Post-op disposition:ICU