Motor and somatosensory evoked potential spinal cord monitoring during intubation and neck extension for thyroidectomy in a Down syndrome boy with atlantoaxial instability

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• 作者：Raiya Saif Al Bahri ; David B. MacDonald…
• 关键词：Intraoperative monitoring ; Motor evoked potentials ; Somatosensory evoked potentials ; Down syndrome ; Atlantoaxial instability ; Intubation ; Neck extension
• 刊名：Journal of Clinical Monitoring and Computing
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：31
• 期：1
• 页码：231-233
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Anesthesiology; Intensive / Critical Care Medicine; Statistics for Life Sciences, Medicine, Health Sciences;
• 出版者：Springer Netherlands
• ISSN：1573-2614
• 卷排序：31

文摘

Intubation or neck extension can compress the spinal cord in patients with craniocervical instability. Protective motor evoked potential (MEP) and somatosensory evoked potential (SEP) monitoring of these maneuvers is an obvious consideration when these patients undergo already-monitored spinal surgery, but might be overlooked when they undergo other normally unmonitored procedures. Here we report monitoring intubation and neck extension for the unusual indication of thyroidectomy in a Down syndrome boy with atlantoaxial instability. Transcranial electric stimulation thenar MEPs and optimized median nerve SEPs were acquired about every minute throughout intubation and neck extension under propofol and remifentanil anesthesia without neuromuscular blockade. Potentials were stable and there was no neurologic deficit. This approach could protect craniocervical instability patients against cord compression when they undergo intubation and neck extension for surgical procedures that would not otherwise indicate spinal cord monitoring.