Maintenance In Young Patient With Hypertriglyceridemia Undergoing Spine Surgery

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Medically Challenging Case Report Poster 


Amir Abdel-Kader  
Mount Sinai Hospital


David Wax  
Mount Sinai Hospital


23 year old male with history of familial hypertriglyceridemia, complicated by past episodes of pancreatitis, and L1‑S1 spinal stenosis presented for L1‑S1 bilateral laminectomies. Intraoperative neuromonitoring was to be used during the case per surgeon request. Maintenance for such cases commonly consists of high dose propofol and opioid infusions to avoid paralysis and inhaled anesthetics to optimize intraoperative neuro-monitoring . Since propofol infusions have been associated with the development of hypertriglyceridemia and pancreatitis, albeit usually in critically ill patients receiving prolonged infusions, we opted to maintain him on low dose (50 mcg/kg/min) propofol, moderate (0.3 mcg/kg/min) remifentanil, and high dose (1.5 mg/kg/hr) ketamine infusion with a bolus (1.5 mg/kg) to start.

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Enter up to two references.

1. Deiner, Stacie. “Highlights of Anesthetic Considerations for Intraoperative Neuromonitoring.” Seminars in Cardiothoracic and Vascular Anesthesia, vol. 14, no. 1, Mar. 2010, pp. 51–53, doi:10.1177/1089253210362792.