Reblogged: Neuromonitoring Mishap for Anterior Cervical Discectomy & Fusion
Reblogged from: Case Reports in Anesthesia
Blog with interesting cases and/or problems related to anesthesia with discussion based on best evidence in the literature.
Neuromonitoring mishap for ACDIF
A female patient with neck pain radiating to her arms comes for a two level anterior decompression and instrumentation for fusion of C5-6 C6-7. She has a history of Asthma for which she has been hospitalized in the recent past. She has no other relevant PMH and has taken several puffs from her inhaler prior to proceeding to the operating room. Induction is smooth and intubation without incident. Neuromonitoring utilizing somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) will be used for the case to ensure that the anterior and posterior tracts of the spinal cord are not compromised. Anesthesia is maintained with desflurane at 5%, fentanyl with intermittent boluses, and an infusion of dexmedotomidine (Precedex) is begun at a rate of 0.4 mcg/kg/hr. No paralysis is used. The patient’s vital signs remained stable throughout case.
After the instrumention is placed and the surgeon is ready to close, the technicion notifies the surgeon that while the SSEPs remain at baseline, the MEPs have declined dramatically, although still present and otherwise normal in appearance. Based on this information from the neuromonitoring tech, the surgeon removes the some of the hardware. This action provides no improvement in the MEPs. Within 30 minutes, MEPS improve back toward baseline. At the time MEPs decreased desflurane was decreased to aproximately 3%, and vital signs were carefully monitored.
What do you think about this case? Is this a real change in MEP’s or not?
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Read the entire report: Case Reports in Anesthesia – Neuromonitoring mishap for ACDIF