Al Bahri Raiya Saif, MacDonald David B, Mahmoud Ahmed Haroun M
Department of Anesthesia, King Faisal Specialist Hospital and Research Center, MBC 22, PO Box 3354, Riyadh, 11211, Saudi Arabia.
Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center, MBC 76, PO Box 3354, Riyadh, 11211, Saudi Arabia.
J Clin Monit Comput. 2017 Feb;31(1):231-233. doi: 10.1007/s10877-016-9832-x. Epub 2016 Jan 28.
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.
对于患有颅颈不稳定的患者，气管插管或颈部伸展可能会压迫脊髓。当这些患者接受已进行监测的脊柱手术时，对这些操作进行保护性运动诱发电位（MEP）和体感诱发电位（SEP）监测是一个明显的考虑因素，但当他们接受其他通常不进行监测的手术时，这一点可能会被忽视。在此，我们报告了对一名患有寰枢椎不稳定的唐氏综合征男孩进行甲状腺切除术这一不寻常适应证时的气管插管和颈部伸展监测情况。在丙泊酚和瑞芬太尼麻醉且无神经肌肉阻滞的情况下，在整个气管插管和颈部伸展过程中，大约每分钟采集一次经颅电刺激拇短展肌MEP和优化后的正中神经SEP。电位稳定，且未出现神经功能缺损。当颅颈不稳定患者因原本无需进行脊髓监测的手术而接受气管插管和颈部伸展时，这种方法可以保护他们免受脊髓压迫。
