Low‐dose sevoflurane co‐administered with propofol‐based general anaesthesia obliterates intra‐operative neurophysiological monitoring in an infant

Abstract

SummaryThe influence of general anaesthetic agents on intra‐operative neurophysiological monitoring in neonates and infants has rarely been reported. Propofol‐based anaesthesia is recommended to avoid suppression of neurophysiological monitoring. However, the administration of propofol in children undergoing prolonged procedures, especially those younger than six months, should be carefully controlled due to the potential risk of propofol infusion syndrome. Adding a small dose of inhalational anaesthetic can be an option to reduce propofol requirements. Recent guidelines in Japan suggest limiting inhalational anaesthetics to less than 0.5 minimum alveolar concentrations when co‐administered with low‐dose propofol during intra‐operative neuromonitoring. However, there is still insufficient evidence regarding the impact of sevoflurane on neurophysiological monitoring when co‐administered with propofol in infants. This report describes a case of a three‐month‐old infant undergoing spinal lipoma resection in which there was a dramatic suppression of neurophysiological monitoring with the addition of 0.35–0.45% sevoflurane to propofol‐based anaesthesia.

Impact of low-dose sevoflurane with propofol-based anaesthesia on motor-evoked potentials in infants: protocol for a single-centre randomised controlled study

“… 3 In contrast, we reported a case of an infant that showed the eminent suppression of intraoperative MEPs induced by administering low-dose sevoflurane (0.10–0.15 age-adjusted MAC) with propofol-based anaesthesia. 7 Another study suggested that younger children (less than 3 years of age) require greater stimulating voltage during IONM due to the immaturity of the central nervous system, which may be more sensitive to anaesthetics compared with adults. Disappearance of IONM can occur with low-dose anaesthetics in this paediatric population, potentially leading to misleading surgical strategies, which is detrimental to patients.…”

“…In addition, we previously reported the case of an infant whose MEP was significantly suppressed when sevoflurane, with an age-adjusted MAC of 0.10–0.15, was combined with a propofol-based TIVA. 7 Another case series of 19 infants retrospectively evaluated the impact of various anaesthetic regimes on MEP. The study demonstrated that adding even low-dose sevoflurane to propofol-based TIVA suppressed MEP in infants.…”