Neuromuscular Scoliosis Spinal Fusion — Loss of Signals — Clinical Pathway
Neuromuscular Scoliosis Spinal Fusion — Loss of Signals — Clinical Pathway
Loss of Signals
Initial Response
- Increase MAP to 75 mm Hg (consider decreasing anesthetic, phenylephrine)
- Consider transfusion for Hgb below 10 g/dl
- Explore mechanical causes related to instrumentation
- Communicate with neurophysiologist throughout the event to monitor for improvement in neuromonitoring signals
- Activate the Anesthesia Now algorithm and display on OR monitors and/or consult the Pedi Crisis App to help guide management
Additional Measures
- Methylprednisolone bolus 30 mg/kg over 15 min and infusion 5.4 mg/kg/hour if no improvement with above interventions
- Note: the data on the efficacy of this approach is not clear. Consider discussion between surgery, anesthesia and PICU
- Consider a wake-up test if etiology of signal loss remains unclear
- Consider stopping surgery and transferring to the ICU