Anesthesia management during meningomyelocele repair alongside motor-evoked potentials in a newborn and a small infant
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ORIGINAL ARTICLE
Anesthesia management during meningomyelocele repair alongside motor-evoked potentials in a newborn and a small infant Gokce Gisi 1 & Omer Faruk Boran 1 Received: 11 April 2019 / Accepted: 12 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Intraoperative neuromonitoring has become an increasingly commonly applied practice during surgical operations for preventing formation of neurological damage. Although it has been used on adults for a long time, the benefits and techniques of applying it in small children are not clear. We applied two different anesthesia protocols during meningomyelocele repair alongside motorevoked potentials in a newborn and a small infant. We discussed our anesthesia management method and the effects of anesthesia on intraoperative neuromonitoring in our two very young cases in only one of which we obtained significant records. Keywords Intraoperative monitoring . Meningomyelocele . Motor-evoked potentials . Pediatrics
Introduction Meningomyelocele is a congenital malformation that occurs as a result of failure in closure of the neural tube in the 3rd–4th week in the intrauterine period. It requires early surgical repair in the first few postpartum days [1]. Intraoperative neurophysiologic monitoring (IONM) is a monitorization technique that is used in the field of surgery to recognize the important neurological structures and prevent neurological damage during surgery, and it is widely used in neurosurgery today. The main modalities for IONM are motor-evoked potentials (MEPs), somatosensory-evoked potentials (SSEPs), and electromyography (EMG) [2, 3]. Although IONM has been used for a long time and is well known for its benefits in adults, there is still uncertainty about the usefulness and techniques of its usage in children. Selection of anesthetic drugs and changing physiological conditions during surgery may severely depress IONM. As neural structures have not completed their development in pediatric patients, especially newborns and infants, there may be difficulties in implementing IONM [4]. This is why we wanted to present our method of anesthesia in our two meningomyelocele cases that were intraoperatively monitored * Gokce Gisi [email protected] 1
Faculty of Medicine, Department of Anesthesiology and Reanimation, Sutcu Imam University, Kahramanmaras, Turkey
by motor-evoked potentials and discuss the anesthesia method for MEP in newborns and infants in the light of recent information.
Case 1 The 2-day-old male baby who was diagnosed with meningomyelocele in the 41st postpartum week with the weight of 3390 g but had mobile lower extremities was taken into the operating room for defect repair. After he was monitored by noninvasive blood pressure measurement, peripheral oxygen saturation (sp02), and electrocardiography (ECG) and preoxygenated by 100% oxygen, intravenous anesthesia induction was achieved by 2 mg/kg ketamine and 1 mcg/kg remifentanil. After suppressing spontaneous respiration, the patient was intubated by an uncuf
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