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Anesthetic Management and Role of Dexmedetomidine During Intraoperative Wake Up Test in Juvenile Idiopathic Scoliosis Correction Surgery: A Case Report

Received: 18 April 2019     Accepted: 11 June 2019     Published: 29 June 2019
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Abstract

Although neurophysiologic monitoring has been continuously developing, a wake-up test is still regarded as gold standard to detect intraoperative motor dysfunction for scoliosis correction surgery. When the wake-up test is being performed, a calm and co-operative patient is truly required. Anesthesia for the wake-up test is one of the greatest challenges for anesthesiologists. One of the anesthesia for the test includes dexmedetomidine. Dexmedetomidine has sedative, analgesic and sympatholytic properties, suitable for the wake-up test procedures. This report aims to demonstrate results of dexmedetomidine to detect the intraoperative motor dysfunction for the scoliosis correction surgery during the performed wake up test. This patient was 11 years old. She was diagnosed juvenile idiopathic scoliosis with the Cobb’s angle 55 degrees. She was scheduled for posterior fusion scoliosis correction with the intraoperative wake-up test. After the surgeon team requested the wake-up test, desflurane was discontinued, but dexmedetomidine was continued with the infusion. The test took only eight minutes before the patient’s awakening with satisfying condition. The girl was perfectly co-operative without any postoperative recalls. During the wake-up test, dexmedetomidine was suggested as a kind of pertinent anesthetic considerations. Its properties were of analgesic, sedative, sympatholytic, and neuro-protective properties.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 7, Issue 1)
DOI 10.11648/j.ijacm.20190701.15
Page(s) 27-30
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Dexmedetomidine, Scoliosis, Wake-Up, Idiopathic

References
[1] Entwistle MA, Patel D. Scoliosis surgery in children. Continuing Education in Anaesthesia Critical Care & Pain 2006; 6: 13-6.
[2] Kunakornsawat S, Popan N, Piyaskulkaew C, Pruttikul P, Pluemvitayaporn T, Kittithamvongs P. Prevalence of Idiopathic Scoliosis in Thai Female Students Aged 11-13 Years. J Med Assoc Thai 2017; 100: 533-8.
[3] Aaron L. Zuckerberg, Myon Yaster. Anesthesia for pediatric orthopedic surgery. Smith’s anesthesia for infants and children. 9th ed. St. Louis, Missouri: Elsevier 2017. P865-891.
[4] Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res 1973: 173-8.
[5] Laratta JL, Ha A, Shillingford JN, Makhni MC, Lombardi JM, Thuet E, et al. Neuromonitoring in Spinal Deformity Surgery: A Multimodality Approach. Global Spine Journal 2017; 8: 68-77.
[6] Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol 2008; 21: 457-61.
[7] Bagatini A, Volquind D, Rosso A, Trindade RD, Splettstosser JC. [Dexmedetomidine as adjuvant drug for wake-up test during scoliosis correction surgery: case report]. Rev Bras Anestesiol 2004; 54: 247-5.
[8] Lowe Thomas G., Edgar Michael M., Margulies Joseph Y., Miller Nancy H., Raso V. James, et al. Etiology of Idiopathic Scoliosis: Current Trends in Research. The Journal of Bone and Joint Surgery 2000; 82 (8): 1157.
[9] Uri Michael Ahn, Nicholas U. Ahn, Leelakrishna Nallamshetty, Jacob M. Buchowski, et al. The etiology of adolescent idiopathic scoliosis. American journal of orthopedics 2002; 31 (7): 387-395.
[10] Grottke O, Dietrich PJ, Wiegels S, Wappler F. Intraoperative wake-up test and postoperative emergence in patients undergoing spinal surgery: a comparison of intravenous and inhaled anesthetic techniques using short-acting anesthetics. Anesth Analg 2004; 99: 1521-7.
[11] Jaap Vuyk, Elske Sitsen, Marije Reekers. Intravenous Anesthetics. Miller’s Anesthesia. 8th ed. Philadephia: Elsevier 2015. p 821-1008.
[12] Ibraheim OA, Abdulmonem A, Baaj J, Zahrani TA, Arlet V. Esmolol versus dexmedetomidine in scoliosis surgery: study on intraoperative blood loss and hemodynamic changes. Middle East J Anaesthesiol 2013; 22: 27-33.
[13] Nasr IA, Qassem YA, Taalab HF, Soliman HF. The quality of the wake-up test in patients undergoing corrective spinal surgery: a comparison of two different anesthetic techniques. Ain-Shams J Anesthesiol 2013; 6: 120-4.
[14] F.-Y. He, W.-Z. Feng, J. Zhong, W. Xu, H.-Y. Shao, Y.-R. Zhang. Effects of propofol and dexmedetomidine anesthesia on Th1/Th2 of rat spinal cord injury. European Review for Medical and Pharmacological Sciences. 2017; 21: 1355-1361
[15] Bo Fang, Xiao-Qian, Li Bo Bi, Wen-Fei Tan, Gang Liu, Ying Zhang, Hong Ma. Dexmedetomidine Attenuates Blood-Spinal Cord Barrier Disruption Induced by Spinal Cord Ischemia Reperfusion Injury in Rats. Cell Physiol Biochem 2015; 36: 373-383.
[16] Hui Rong, Zhibin Zhao, Jiying Feng, Yishan Lei, Hao Wu, et al. The effects of dexmedetomidine pretreatment on the pro- and anti-inflammation systems after spinal cord injury in rats. Brain, Behavior, and Immunity 64 (2017) 195–207.
[17] Lao L, The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. Journal of Orthopaedic Surgery and Research. 2013; 8 (1): 32.
[18] Anderson PR, Puna MR. Lovell SL, Swayze CR. Postoperative respiratory complications in non-idiopathic scoliosis. Acta Anaesthesiol Scand. 1985; 29 (2): 186-92.
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  • APA Style

    Pipat Saeyup, Chanon Thanaboriboon. (2019). Anesthetic Management and Role of Dexmedetomidine During Intraoperative Wake Up Test in Juvenile Idiopathic Scoliosis Correction Surgery: A Case Report. International Journal of Anesthesia and Clinical Medicine, 7(1), 27-30. https://doi.org/10.11648/j.ijacm.20190701.15

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    ACS Style

    Pipat Saeyup; Chanon Thanaboriboon. Anesthetic Management and Role of Dexmedetomidine During Intraoperative Wake Up Test in Juvenile Idiopathic Scoliosis Correction Surgery: A Case Report. Int. J. Anesth. Clin. Med. 2019, 7(1), 27-30. doi: 10.11648/j.ijacm.20190701.15

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    AMA Style

    Pipat Saeyup, Chanon Thanaboriboon. Anesthetic Management and Role of Dexmedetomidine During Intraoperative Wake Up Test in Juvenile Idiopathic Scoliosis Correction Surgery: A Case Report. Int J Anesth Clin Med. 2019;7(1):27-30. doi: 10.11648/j.ijacm.20190701.15

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  • @article{10.11648/j.ijacm.20190701.15,
      author = {Pipat Saeyup and Chanon Thanaboriboon},
      title = {Anesthetic Management and Role of Dexmedetomidine During Intraoperative Wake Up Test in Juvenile Idiopathic Scoliosis Correction Surgery: A Case Report},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {7},
      number = {1},
      pages = {27-30},
      doi = {10.11648/j.ijacm.20190701.15},
      url = {https://doi.org/10.11648/j.ijacm.20190701.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20190701.15},
      abstract = {Although neurophysiologic monitoring has been continuously developing, a wake-up test is still regarded as gold standard to detect intraoperative motor dysfunction for scoliosis correction surgery. When the wake-up test is being performed, a calm and co-operative patient is truly required. Anesthesia for the wake-up test is one of the greatest challenges for anesthesiologists. One of the anesthesia for the test includes dexmedetomidine. Dexmedetomidine has sedative, analgesic and sympatholytic properties, suitable for the wake-up test procedures. This report aims to demonstrate results of dexmedetomidine to detect the intraoperative motor dysfunction for the scoliosis correction surgery during the performed wake up test. This patient was 11 years old. She was diagnosed juvenile idiopathic scoliosis with the Cobb’s angle 55 degrees. She was scheduled for posterior fusion scoliosis correction with the intraoperative wake-up test. After the surgeon team requested the wake-up test, desflurane was discontinued, but dexmedetomidine was continued with the infusion. The test took only eight minutes before the patient’s awakening with satisfying condition. The girl was perfectly co-operative without any postoperative recalls. During the wake-up test, dexmedetomidine was suggested as a kind of pertinent anesthetic considerations. Its properties were of analgesic, sedative, sympatholytic, and neuro-protective properties.},
     year = {2019}
    }
    

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    AU  - Pipat Saeyup
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    AB  - Although neurophysiologic monitoring has been continuously developing, a wake-up test is still regarded as gold standard to detect intraoperative motor dysfunction for scoliosis correction surgery. When the wake-up test is being performed, a calm and co-operative patient is truly required. Anesthesia for the wake-up test is one of the greatest challenges for anesthesiologists. One of the anesthesia for the test includes dexmedetomidine. Dexmedetomidine has sedative, analgesic and sympatholytic properties, suitable for the wake-up test procedures. This report aims to demonstrate results of dexmedetomidine to detect the intraoperative motor dysfunction for the scoliosis correction surgery during the performed wake up test. This patient was 11 years old. She was diagnosed juvenile idiopathic scoliosis with the Cobb’s angle 55 degrees. She was scheduled for posterior fusion scoliosis correction with the intraoperative wake-up test. After the surgeon team requested the wake-up test, desflurane was discontinued, but dexmedetomidine was continued with the infusion. The test took only eight minutes before the patient’s awakening with satisfying condition. The girl was perfectly co-operative without any postoperative recalls. During the wake-up test, dexmedetomidine was suggested as a kind of pertinent anesthetic considerations. Its properties were of analgesic, sedative, sympatholytic, and neuro-protective properties.
    VL  - 7
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Author Information
  • Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

  • Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

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