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Case Reports
. 2020 Feb 11;13(2):e231276.
doi: 10.1136/bcr-2019-231276.

Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion

Evangeline Ko Villa  1 , Dominic Villa  2 , Rafael C Bundoc  3
Affiliations
Case Reports

Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion

Evangeline Ko Villa et al. BMJ Case Rep. .

Abstract

A 9-year-old female with Trisomy 21 with complex craniovertebral instability causing severe cervicomedullary compression underwent occipitocervical fusion. This paper will discuss the anaesthetic management and highlight the use of the Narcotrend monitor not only as a depth of consciousness monitor but more importantly as a tool to detect surgery-induced cerebral hypoperfusion by monitoring the right and left cerebral hemispheres independently and simultaneously.

Keywords: anaesthesia; healthcare improvement and patient safety; orthopaedic and trauma surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Three-dimensional reconstruction of patient’s CT scan showing irreducible C1C2 instability.
Figure 2
Figure 2
MRI showing severe spinal canal stenosis.
Figure 3
Figure 3
Three-dimensional printed model of patient’s skull base and cervical spine showing extent of planned decompression.
Figure 4
Figure 4
Depiction of planned surgical approach using 3D printed model of patient’s skull base and cervical spine and patient-specific drill guide template. 3D, three dimensional.
Figure 5
Figure 5
Narcotrend two-channel lead electrodes being checked and readjusted to address the impedance shown in the Narcotrend monitor.
Figure 6
Figure 6
Patient placed in the prone position with Narcotrend two-channel leads in place. The raw EEG waves from the right and left side of the brain monitored independently and simultaneously are shown on the upper portion of the screen. The Narcotrend stage and index showing anaesthetic depth is depicted on the lower left portion of the screen. Cerebrogram is depicted in the right lower portion showing the trend of Narcotrend stage. EEG, electroencephalography.
Figure 7
Figure 7
Monitor view of the navigation system used for anatomic guidance intraoperatively.
Figure 8
Figure 8
Narcotrend stage (A–F), Narcotrend index (0–100) and clinical interpretation.
Figure 9
Figure 9
Narcotrend one-channel mode lead placement.
Figure 10
Figure 10
Narcotrend screen showing the one-channel mode.
Figure 11
Figure 11
Narcotrend two-channel mode lead placement.
See this image and copyright information in PMC

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