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Intraoperative wake-up test in neonatal neurosurgery
Ramasamy Govindarajan1, Oluwaseun Babalola, Magdy Gad-El-Kareem
1Department of Anesthesiology, Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA.
Paediatric Anaesthesia
|April 19, 2006
Summary
This study details a successful intraoperative wake-up test (WPT) in a newborn undergoing myelomeningocele repair. The modified technique ensured accurate spinal cord monitoring in an infant, crucial for neonatal neurosurgery.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pediatric Surgery
Background:
- The intraoperative wake-up test (WPT) is the gold standard for monitoring anterior spinal cord function during spinal surgery.
- WPT requires patient cooperation, posing challenges in pediatric patients, especially neonates.
Observation:
- A modified WPT was successfully performed in a newborn during myelomeningocele repair.
- The technique involved careful anesthetic management using desflurane, propofol infusion, and BIS monitoring.
- Lidocaine infusion was used to improve tracheal tube tolerance and manage intracranial pressure.
Findings:
- The WPT was deemed satisfactory, confirmed by lower extremity motor responses (flexion/extension) correlated with BIS values and preoperative status.
- This methodology allowed for safe and effective neuromonitoring in a neonatal patient.
Implications:
- This modified WPT provides a viable method for intraoperative neuromonitoring in neonates undergoing complex spinal procedures.
- It enables early detection of neurological deficits, which is critical given the challenges of assessing infants post-extubation.
- The described approach can be repeated if necessary, enhancing safety in neonatal neurosurgery.