Back cases
Back cases
- The surgeons often use SEP’s (somatosensory evoked potential tests) and EMG’s (electromyography)
- We can only use 0.5 MAC of our volatile anesthetics or we will suppress the SEPs
- Relaxants will suppress EMG
- An initial dose of rocuronium is okay because they don’t start monitoring EMG for about 1 hour after the case begins
- We should supplement the volatile agent with a propofol / remifentanyl infusion
- Ask the neuro-monitoring tech about anesthesia type needed
- Laminectomy: blood loss not a problem
- Fusion: watch the blood loss as it can be significant. You can lose 800 to 1000 cc. Use a cell saver and increase the fluid administration.
- To end a back case: turn off the remifentanil pump as closure begins. Decrease the desflurane a bit also. Titrate fentanyl prn.
- Prone cases: give glycopyrrolate to dry secretions.
- Refer to the ‘RWSC, back cases’ notation.
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