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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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05-10-2022 | Transesophageal Echocardiography | Case Reports / Case Series

Novel use of transesophageal echocardiography to optimize hemodynamics and patient positioning during prone scoliosis surgery and safety considerations in the setting of intraoperative neuromonitoring: a case report

Authors: Kim Phan, BSc, Adele Budiansky, MD, Elizabeth Miller, MD, Philippe Phan, MD, Daniel Dubois, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 12/2022

Abstract

Purpose

The prone position can lead to anatomical compression of the thoracic cavity resulting in reduced cardiac output, especially in the context of chest wall deformities commonly present in patients with scoliosis. There are no protocols for using transesophageal echocardiography (TEE) to optimize prone positioning and for safe use of TEE during cases requiring neuromonitoring.

Clinical features

We present a case of a 23-yr-old male with Cornelia de Lange syndrome undergoing elective posterior spinal fusion for syndromic scoliosis who developed severe refractory hypotension and cardiac arrest in the prone position. After hemodynamic stabilization in the intensive care unit, the patient returned to the operating room on postoperative day 2 for completion of his spinal fusion. Transesophageal echocardiography determined the optimal position of longitudinal bolster placements associated with minimal left ventricular compression in the supine position. The patient was then proned and intraoperative hemodynamics during the second surgery remained stable. Owing to the special considerations of using TEE in the prone position with neuromonitoring, we describe technical aspects to consider to protect the equipment and patient.

Conclusion

Patients with compliant chest walls or thoracic deformities are at risk of hemodynamic instability in the prone position. Intraoperative TEE can be used in the supine patient prior to proning to determine optimal longitudinal bolster positioning to minimize cardiac compression. Transesophageal echocardiography used during spine surgery in the prone position with neuromonitoring and motor-evoked potentials requires special considerations for patient safety.

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Title: Novel use of transesophageal echocardiography to optimize hemodynamics and patient positioning during prone scoliosis surgery and safety considerations in the setting of intraoperative neuromonitoring: a case report
Authors: Kim Phan, BSc
Adele Budiansky, MD
Elizabeth Miller, MD
Philippe Phan, MD
Daniel Dubois, MD
Publication date: 05-10-2022
Publisher: Springer International Publishing
Keywords: Transesophageal Echocardiography
Scoliosis
Motor Evoked Potential
Motor Evoked Potential
Neuromonitoring
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 12/2022
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02334-w

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Novel use of transesophageal echocardiography to optimize hemodynamics and patient positioning during prone scoliosis surgery and safety considerations in the setting of intraoperative neuromonitoring: a case report

Abstract

Purpose

Clinical features

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Clinical features

Conclusion

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