Acta Scientific Pharmacology

Case Report Volume 3 Issue 6

Delayed Recovery of a Prolonged Total IntraVenous Anesthesia Procedure with Risks of Malignant Hyperthermia

Amit Aggarwal*, Annum Faisal and Mahammad Hussain

Department of Anesthesiology, University of North Texas Health Science Center - Texas College of Osteopathic Medicine, United States of America

*Corresponding Author: Amit Aggarwal, Department of Anesthesiology, University of North Texas Health Science Center - Texas College of Osteopathic Medicine, United States of America.

Received: November 03, 2021 Published: May 27, 2022


Background: Spinal Cord Ependymoma (SCE) is an intramedullary tumor that requires surgical intervention. Total Intravenous Anesthesia (TIVA) is indicated for such neurosurgery cases. The pharmacodynamics and pharmacokinetics of each drug used must be factored to safely extubate and maintain the airway postoperatively.

Case: A 57-year-old male with a history of pulmonary hypertension presented to the hospital with complaints of gait difficulty and sensory deficits secondary to SCE. The patient was scheduled for surgery, and the decision was made to do TIVA due to a family history of Malignant Hyperthermia. Three continuous IV drips were placed: propofol, titrated between 125-300 mcg/kg/min, ketamine at 5 mcg/kg/min, and sufentanil at 0.3 mcg/kg/hr. The patient required a phenylephrine infusion at 35 mcg/min to maintain hemodynamics, which had to be titrated up to 75mcg near the 11-hour point due to severe hypotension. Following extubation, the patient was placed on an oral airway with a simple O2 mask in place. He was noted to have snoring respirations with oxygen desaturating to the low 80’s. A jaw thrust was done, and he was placed on a non-rebreather mask. Due to a fixed obtunded state, a hasty decision to re-intubate was made without proper revaluation and communication between providers. The patient was then re-extubated 1.5 hours later with minimal post-op complications.

Conclusion: This case illustrates the challenges of prolonged TIVA in the assessment of safely extubating patients while maintaining the airway in the postoperative period.

Keywords: Spinal Cord Ependymoma (SCE); Total Intravenous Anesthesia (TIVA); Airway


  1. Barzin M and Maleki I. “Incidence of Vertebral Hemangioma on Spinal Magnetic Resonance Imaging in Northern Iran”. Pakistan Journal of Biological Sciences6 (2009): 542-544.
  2. Celano E., et al. “Spinal cord ependymoma: a review of the literature and case series of ten patients”. Journal of Neuro-Oncology3 (2016): 377-386.
  3. Gepts E., et al. “Linearity of Pharmacokinetics and Model Estimation of Sufentanil”. Anesthesiology 6 (1995): 1194-1204.
  4. Nimmo A., et al. “Guidelines for the safe practice of total intravenous anaesthesia (TIVA)”. Anaesthesia 2 (2018): 211-224.
  5. Misal U., et al. “Delayed recovery from anesthesia: A postgraduate educational review”. Anesthesia: Essays and Researches2 (2016): 164.
  6. Phan K., et al. “Anesthesia Duration as an Independent Risk Factor for Early Postoperative Complications in Adults Undergoing Elective ACDF”. Global Spine Journal8 (2017): 727-734.
  7. Zuleta-Alarcón A., et al. “Total intravenous anaesthesia versus inhaled anaesthetics in neurosurgery”. Colombian Journal of Anesthesiology 43 (2015): 9-14.
  8. Ingrande J and H J M Lemmens. “Dose Adjustment of Anaesthetics in the Morbidly Obese”. OUP Academic, BJA: British Journal of Anaesthesia1 (2010).


Citation: Amit Aggarwal., et al. “Delayed Recovery of a Prolonged Total IntraVenous Anesthesia Procedure with Risks of Malignant Hyperthermia". Acta Scientific Pharmacology 3.6 (2022): 13-15.


Copyright: © 2022 Amit Aggarwal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate36%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is June 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US