Anesthesia Considerations for Monitoring TCMEPs in Adults Diagnosed with Poliomyelitis as Children: A Case Report

Abstract

ABSTRACT.The use of transcranial motor evoked potentials (TCMEPs) to detect and hopefully prevent injury to the brain, spinal cord, and peripheral nerves intraoperatively has increased greatly in recent years. It is well established that in addition to certain anesthetic agents, patient factors such as advanced age, obesity, diabetes, hypertension, and a collection of neurological and neuromuscular diseases and disorders can greatly reduce or completely eliminate the ability to monitor TCMEPs effectively. One such disease, poliomyelitis (polio), is a highly contagious viral disease that has been mostly forgotten since its near-eradication through vaccination. Over the past three decades there has been increasing recognition of late onset neurological deterioration in individuals who were afflicted by, and apparently recovered from, paralytic poliomyelitis much earlier in life. This condition is known as post-poliomyelitis syndrome (PPS). Patients that appear to have fully recovered from polio, and those with PPS, may require special anesthetic considerations to facilitate effective TCMEP monitoring. Case Report: We report the rapid loss of only lower extremity TCMEPs bilaterally during a C6-C7, C7-T1 ACDF in a 67-year-old female to treat left-sided C7-C8 radiculopathy and C6-T1 foraminal stenosis. The general anesthetic maintenance regimen of 0.3 MAC sevoflurane and 100 μg/kg/min propofol was paused, and a wake-up test was initiated. Full upper and lower extremity motor function was observed. A thorough review of the patient's medical history revealed the potential risk factor of full recovery from poliomyelitis as a child. The sevoflurane was removed from the anesthetic regimen, and the lower extremity TCMEPs returned and were present for the remainder of the surgery.