Anaesthetic management of a three-month-old baby for cervical limited dorsal myeloschisis repair using propofol and alfentanil infusions guided by pharmacokinetic simulation software: A case report

  • E Coetzee University of Cape Town
  • R Gray University of Cape Town
  • C Hollmann University of Cape Town
  • N J M Enslin University of Cape Town
  • J F Coetzee Stellenbosch University
Keywords: cervical limited dorsal myeloschisis, intraoperative neuromonitoring (IONM), total intravenous anaesthesia (TIVA), target controlled infusion (TCI), paediatric anaesthesia

Abstract

We present an uncommon case of limited dorsal myeloschisis in a 3-month-old infant requiring repair guided by intraoperative neuromonitoring (IONM) and therefore avoidance of volatile anaesthetic agents. The case presented challenges in positioning, airway management, a lack of age appropriate pharmacokinetic models in target-controlled infusion (TCI) syringe pumps and unavailability of remifentanil, considered to be an essential drug in this setting. We overcame these challenges using manually controlled infusions of propofol and alfentanil guided by pharmacokinetic simulation software (Stelsim).

Author Biographies

E Coetzee, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa

R Gray, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa

C Hollmann, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa

N J M Enslin, University of Cape Town

Division of Neurosurgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa

J F Coetzee, Stellenbosch University

Department of Anaesthesiology and Critical Care, Stellenbosch University, South Africa

Published
2019-12-04
Section
Case Studies