Wake-up test during major spinal surgery under remifentanil balanced anaesthesia.
Damage to spinal cord and subsequent neurological deficit is a recognised complication of major spinal surgery. It may be produced by a number of causes, not last excessive stretching when surgical instrumentation is positioned; it is easy to understand that early intraoperative warning of potential damage is highly desiderable. Wake-up test is a simple, safe and reliable method of recognition of such a complication, allowing rapid neurological recovery by reduction of spinal distraction. Remifentanil belongs to a new pharmacokinetic class of opioids (EMO: Esterase Metabolised Opioid) undergoing rapid biotransformation to minimally active metabolites, showing a short and predictable duration of action with no effect of accumulation. Authors describe a first 10 patient series subjected to wake-up-test during spinal surgery under remifentanil balanced anaesthesia. The protocol the authors set up allowed a very rapid intraoperative neurological examination (in average less than 5 min), without pain and/or disagreement for the patient and no complication related to the test was observed. Authors conclude that the use of Remifentanil for intraoperative awakening during major spinal surgery seems to be a safe, reliable and pratictical method to detect very quickly any potential neurological damage during the operation.
Rodolà
F
F
Istituto di Anestesiologia e Rianimazione, Catholic University of Sacred Heart, Rome, Italy.
D'Avolio
S
S
Chierichini
A
A
Vagnoni
S
S
Forte
E
E
Iacobucci
T
T
D000701:Analgesics, Opioid; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D010880:Piperidines; D000077208:Remifentanil; D013116:Spinal Cord / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000175:diagnosis*
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil