Unilateral External Anal Sphincter MEP Monitoring in a Case of Conus Medullaris Tumor.

The use of intraoperative neurophysiological monitoring is a helpful tool during surgeries of conus medullaris tumors and helps in reducing the risk of post-operative functional compromise like paraparesis, sensory deficits, or urological dysfunctions. External anal sphincter (EAS) motor evoked potential (MEP) monitoring is usually done for monitoring sacral nerve roots and to prevent post-operative neurological deficits. Here we describe a case where unilateral motor cortical stimulation aided us to differentiate the laterality of TcMEP responses in EAS.

Anaesthetic management of a case of Haberland's syndrome (encephalocraniocutaneous lipomatosis).

While the Haberland syndrome was first reported in 1970, the anaesthetic management of this rare cohort of patients has not been described. With only 54 such cases reported, describing primarily the unilateral cutaneous, ocular, and neurologic malformations associated with this syndrome without focussing on the anaesthetic management. We describe the case of a 7 year old case of Harberland syndrome with special focus on the difficulties faced by us in mask ventilation, as well as intubation and the need for elective ventilation and planned extubation. We also discuss the precautions to be taken while undertaking such a case like preparations for emergency tracheostomy and possibility of re-intubation after extubation. A meticulous preoperative workup along with neurological and airway examination along with preparation for elective ventilation and tracheostomy is a prerequisite for the successful management of this case.

Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial.

BACKGROUND AND AIMS: The study was conceived to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol (total intravenous anesthesia) on anesthetic dose reduction and anesthesia recovery parameters in cerebello-pontine angle (CPA) surgeries. MATERIAL AND METHODS: This prospective randomized study was conducted on 49 patients (25 with dexmedetomidine, 24 without). After standardized anesthetic induction, anesthesia was maintained using propofol (via target controlled infusion, titrated to maintain BIS between 40 and 60), fentanyl (0.5 µg/kg/hour) and either dexmedetomidine (0.5 µg/kg/hour) or a sham infusion. Neuromuscular blocking agents were excluded to allow cranial nerve EMG monitoring. Adverse hemodynamic events, recovery parameters (time to opening eyes, obeying commands, and extubation) and postoperative sedation score, shivering score, nausea, and vomiting score were recorded. RESULTS: Propofol and fentanyl utilization (as total dose, adjusted for duration of surgery and body weight, and number of extra boluses) was significantly lower in the dexmedetomidine group. There was no difference in any of the recovery parameters between the two groups. Incidence of bradycardia was significantly higher with dexmedetomidine, while no difference was found for hypotension, hypertension, and tachycardia. CONCLUSION: Dexmedetomidine-fentanyl-propofol anesthesia compares favorably with fentanyl-propofol anesthesia during CPA neurosurgical procedures with regard to anesthesia recovery times, but with lower intraoperative opioid and hypnotic utilization rates.