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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

 

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