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Tengku Addi Saputra^*✉ , Iwan Fuadi , Iwan Abdul

1. Departement of Neuroanesthesiology and Critical Care, Medical Faculty Universitas Padjajaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia. 

Abstract

Total intravenous anesthesia (TIVA) has becomemore popular in neuroanesthesia over past decade. Propofol and remifentanil are the most ideal drugs for TIVA. Cases of myeloradicolopathy of tuberculosis infection are significantly increasing in Indonesia. The clinical effects of pain and impaired motor and sensory function will cause activity disorders and affect the quality of life of the sufferer. We present a patient with myeloradiculopathy due to TB infection who underwent stabilization anterior fusion surgery with a tubular cage anterior approach (cervicosternotomy). A 23-year-old woman was diagnosed with Myeloradiculopathy with Space Occupying Lesion Extradural at the Th2-Th4 vertebral level, suspected TB spondylitis with fracture and paravertebral abscess, with ASA (American Society of Anesthesiology) II. The patient was given induction remifentanil 50 mcg, which was given as a bolus for one minute, followed by remifentanil 25 mcg for one minute, propofol 120 mg, and rocuronium 60 mg. Anesthesia maintenance was carried out on patients by administering  remifentanyl infusion 0.05-0.5 mcg/kg/minute, propofol infusion 50-150 mcg/kg/minute, and intermittent rocuronium 10 mg. Preoperative assessment, intraoperative maintenance, and postoperative evaluation were performed in these patients. Preoperative analysis, intraoperative care, intraoperative monitoring, and postoperative monitoring are essential to ensure good outcome results from cervicosternotomy with an anterior approach, which requires very good cooperation between neurosurgery, thoracic surgery, and neuroanesthesia and gives some challenges in itself‎.

Keywords: Anesthesia, Anterior stabilization, Cervicosternotomy, Myeloradiculopathy

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