DISCUSSION:
The recommended surgical management for LDM is full excision of the
intradural stalk from its dural entry point to its merge point with the
spinal cord [9]. IONM can aid in distinguishing the border between
the two structures. This is important because incomplete elimination of
the tethering elements can cause secondary deterioration and additional
follow-up surgeries. Because anesthesia can affect synaptic connections
and alter the evoked potential, anesthesia protocol, and management are
crucial during intraoperative neurophysiological monitoring [8].
The majority of anesthetists favor the total intravenous anesthesia
(TIVA) procedure due to the depressing effects of inhaling drugs on
evoked potentials. In TIVA, propofol is typically preferred in addition
to opioids or other analgesics. In severely ill newborns, patients
without known or suspected mitochondrial illness, or short-duration
procedures (3 hours), propofol infusion syndrome (PrIS) is typically not
a cause for concern during anesthesia [10].
Children’s context-sensitive half-lives are longer than those of adults;
they are 10.4 vs. 6.7 min after a one-hour infusion and 19.6 vs. 9.5 min
after four hours [7]. Although clinical significance is rarely
present, infusion rates can be lowered as cases progress to prevent
protracted recovery durations. In order to obtain the goal plasma
concentration of 3 g/ml suggested by Morse et al., neonates need to
receive a loading dose of 2 mg/kg followed by an infusion rate of 9
mg/kg/hr for the first 15 min, 7 mg/kg/hr from 15 to 30 min, 6 mg/kg/hr
from 30 to 60 min, and 5 mg/kg/hr from 1 to 2 hours [7].