Open AccessAnaesthetic 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
Author(s) -
E. Coetzee,
Rebecca N Gray,
Charleen Hollmann,
N. J. M. Enslin,
J. F. Coetzee
Publication year - 2019
Publication title -
southern african journal of anaesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.175
H-Index - 10
eISSN - 2220-1173
pISSN - 2220-1181
DOI - 10.36303/sajaa.2019.25.6.a5
Subject(s) - alfentanil , propofol , remifentanil , medicine , anesthesia , pharmacokinetics , airway , airway management , pharmacology
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).