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].