Background and objectives: Scoliosis is a spinal defect very often requiring surgical correction. A uniqueness of this correction is the need for intraoperative emergence and leg movement (wake up test) to rule out central nervous system (CNS) injury after correction of the orthopedic defect. In our report, dexmedetomidine was associated to total intravenous anesthesia with propofol and remifentanil to induce sedation, analgesia and ventilatory stability during wake up test in patient submitted to surgical scoliosis correction.
Case report: Caucasian, female patient, 16 years old, physical status ASA I, with lumbar and thoracic scoliosis in 12 levels, submitted to surgery under general anesthesia. Patient was premedicated with 2 mg oral lorazepam the day before and 90 minutes before surgery. Venoclysis and left arm radial artery puncture were performed after monitoring; right subclavian vein was punctured with double lumen catheter for drug infusion and hemodynamic evaluation. Anesthesia was induced with 1 microg.kg-1 remifentanil and propofol in target-controlled infusion, for 3 microg.mL-1 plasma concentration. Neuromuscular block was achieved with 0.5 mg.kg-1 atracurium. Anesthesia was maintained with 0.4 microg.kg-1.h-1 dexmedetomidine and 0.3 microg.kg-1.min-1 remifentanil in continuous infusion, and 3 microg.mL-1 propofol in target-controlled infusion. At lower limbs movement test, propofol and remifentanil were withdrawn, but dexmedetomidine was maintained. Patient returned to spontaneous ventilation with anesthetic recovery and 14 minutes after drug withdrawal patient has moved lower limbs at verbal command. During this procedure, patient remained in Ramsay's sedation stage 3 that is, under analgesia, spontaneous ventilation and relaxed.
Conclusions: Dexmedetomidine associated to total intravenous anesthesia was an interesting option as adjuvant drug for the wake-up test as well as for perioperative analgesia and sedation.