Plus-Hex CLINICAL also have a reduced ability to effectively ventilate. It is therefore important to ensure the patient has received adequate analgesia prior to imaging, it is adequately anaesthetised and its end-tidal carbon dioxide remains within normal limits. Hypercapnia(> 60 mmHg) during anaesthesia can result in acidaemia. This can produce adverse effects including direct negative inotropic effects on the heart, the malfunction of enzymatic pathways [ 10 ] and extensive periods of hypercapnia, which may indicate the need for intermittent positivepressure ventilation of the patient.
As mentioned, MRI requires remote anaesthetic monitoring of the patient using MRI-compatible multiparameter monitoring equipment. In this case, monitoring included pulse oximetry, oscillometric blood pressure readings, capnography, and monitoring of the inspired and expired fraction of isoflurane, as well as the percentage of oxygen and air present in the patient ' s breathing system. These values were used to ensure the patient remained anaesthetically stable throughout the scan. Thick eye lubrication( Xailin Night, VISUfarma) was used to maintain eye moisture throughout anaesthesia, as decreased tear production has been noted secondary to anaesthetic drug use [ 11, 12 ].
Anaesthetic considerations during hemilaminectomy surgery
Once imaging was complete, the patient was prepared for surgery. This included placement of an arterial catheter. In this case, a 22 G catheter was placed in the patient ' s dorsopedal artery. Arterial catheterisation provided real-time representation of the patient ' s blood pressure, allowing quick identification of any deviations in blood pressure throughout the surgery. Hypertension can often indicate nociception [ 13 ], which would trigger intervention, such as rescue analgesia. Only one instance of hypertension was seen in this case, on the first incision, which required a single dose of fentanyl at 1 μg / kg.
Bite-sized modules, accessible anywhere
Conversely, hypotension can result in hypoperfusion and should therefore be avoided throughout anaesthesia to reduce risk of this occurring. Inhalant anaesthetic agents can cause vasodilation, so it is helpful to analyse the end-tidal concentration of these agents alongside the patient ' s anaesthetic depth. This can ensure the depth is suitable while keeping the amount of inhalant anaesthetic agent to the necessary minimum.
Hypotension may also be an indication of blood loss, and it is therefore important to communicate with the VS and to monitor blood loss throughout surgery. Mechanical ventilation can result in a reduction of venous return, which can also be the cause of patient hypotension [ 14 ]. No instances of hypotension were seen in this case, suggesting that the patient was appropriately ventilated
Expert insights & latest research Interactive learning Practical advice & solutions
Register now for your chance to win a
£ 100 Amazon. co. uk Gift Card!
( Restrictions apply. See amazon. co. uk / gc-legal)
and the correct dose of isoflurane was administered to maintain anaesthesia.
Although arterial catheterisation can be a good technique to accurately monitor a patient ' s blood pressure, placement of arterial catheters can be technically challenging and is not always possible. Oscillometric and Doppler blood pressure measurement are alternative, noninvasive methods to monitor blood pressure that will provide valuable information regarding the patient ' s blood pressure. Of these, oscillometric readings are preferred, as a Doppler reading solely provides a systolic blood pressure value.
© 2025 Elanco or its affiliates. Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates.
An ESP nerve block with bupivacaine( 0.5 ml / kg) was performed before surgery. Use of locoregional anaesthetic techniques such as this can reduce the requirement for intraoperative analgesia [ 15 ]. This was demonstrated by the fact that, in this invasive surgery, only one dose of rescue analgesia was required throughout the procedure. As mentioned earlier, this was required at the time of the first incision. As ESP blocks work in the fascial plane, they are not expected to prevent noxious skin stimuli [ 16 ]. Bupivacaine has a
Volume 40( 3) • June 2025
45