Case Studies

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, R. Gray, C. Hollman, J.M.N. Enslin, J.F. Coetzee
Southern African Journal of Anaesthesia and Analgesia | Vol 25, No 6 | a883 | DOI: https://doi.org/10.36303/SAJAA.19.6.A5 | © 2019 E. Coetzee, R. Gray, C. Hollman, J.M.N. Enslin, J.F. Coetzee | This work is licensed under Other
Submitted: 11 November 2025 | Published: 29 December 2019

About the author(s)

E. Coetzee, Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa
R. Gray, Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa
C. Hollman, Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa
J.M.N. Enslin, Division of Neurosurgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa
J.F. Coetzee, Department of Anaesthesiology and Critical Care, Stellenbosch University, South Africa

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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).

Keywords

cervical limited dorsal myeloschisis; intraoperative neuromonitoring (IONM); total intravenous anaesthesia (TIVA); target controlled infusion (TCI); paediatric anaesthesia*

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