Acute hypotension in a patient undergoing posttraumatic cervical spine fusion with somatosensory and motor-evoked potential monitoring while under total intravenous anesthesia: a case report.
Hypotension should be vigilantly prevented in patients with spinal cord injury. Recent advances in neurological, intraoperative monitoring techniques have allowed Certified Registered Nurse Anesthetists to assess the effects of spinal cord ischemia and compression as they occur. This case report describes a young, healthy man who sustained a cervical spine fracture and was scheduled for anterior spinal fusion with somatosensory and motor-evoked potential (MEP) monitoring while under total intravenous anesthesia. This patient experienced a brief period of intraoperative hypotension with evidence of abnormal MEPs. A wake-up test was performed, which showed normal functioning, and the case resumed an uneventful course. Although this scenario resulted in no neurological sequelae, the effects of spinal cord ischemia due to hypotension can lead to permanent, devastating motor and sensory damage.
Cann
David F
DF
Columbia University School of Nursing, New York, New York, USA.
D000328:Adult; D000771:Anesthesia, Intravenous / Q000379:methods*; D002574:Cervical Vertebrae / Q000293:injuries; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D007103:Immobilization; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D016103:Spinal Fractures / Q000601:surgery; D013123:Spinal Fusion