Medical Pharmacology Clinical Case: Anesthesia

Medical Pharmacology: General Anesthesia Clinical Case Questions

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A 45 year-old man suffered a severe back injury in a motor vehicle accident. He had back pain requiring continuous use of analgesics in the ensuing recovery period, and eventually was scheduled for thoracolumbar spine fusion to relieve developing scoliosis.
The neurosurgeon was anxious to prevent neurologic injury and requested that somatosensory evoked potential (SSEP) monitoring the employed to detect potential nerve injury during the operation.

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D.

What anesthetic agents have the least suppressant effect on SSEP wave forms?
1. potent inhalational agents
2. barbiturates
3. benzodiazepines
4. opioids
Anesthetic protocol: induction -- thiopental (Pentothal) + succinylcholine (Anectine); after intubation, fentanyl (Sublimaze) (150 ug/kg, slowly IV) and nitrous oxide/oxygen mixture (65:35). Why cannot fentanyl (Sublimaze) be used without the nitrous oxide?
1. increase risk of hypotension
2. predisposes to arrhythmias
3. inadequate sympathetic system suppression
4. B & C
5. A, B & C

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