title: Motor and somatosensory evoked potential spinal cord monitoring during intubation and neck extension for thyroidectomy in a Down syndrome boy with atlantoaxial instability.
abstract: 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.
authors.affiliation: Department of Anesthesia, King Faisal Specialist Hospital and Research Center, MBC 22, PO Box 3354, Riyadh, 11211, Saudi Arabia.
authors.forename: Raiya Saif
authors.initials: RS
authors.lastname: Al Bahri
authors.affiliation: Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center, MBC 76, PO Box 3354, Riyadh, 11211, Saudi Arabia. dbmacdon@yahoo.com.
authors.forename: David B
authors.initials: DB
authors.lastname: MacDonald
authors.affiliation: Department of Anesthesia, King Faisal Specialist Hospital and Research Center, MBC 22, PO Box 3354, Riyadh, 11211, Saudi Arabia.
authors.forename: Ahmed Haroun M
authors.initials: AH
authors.lastname: Mahmoud
mesh_terms: D000758:Anesthesia; D002574:Cervical Vertebrae / Q000503:physiopathology; D002648:Child; D004314:Down Syndrome / Q000503:physiopathology*; D004558:Electric Stimulation / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D008991:Monitoring, Physiologic; D009333:Neck / Q000503:physiopathology; D013116:Spinal Cord / Q000473:pathology*; D013965:Thyroidectomy / Q000379:methods
keywords: Atlantoaxial instability; Down syndrome; Intraoperative monitoring; Intubation; Motor evoked potentials; Neck extension; Somatosensory evoked potentials
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