Case 86: A Case of Acoustic Neuroma

Abstract

The removal of a left-sided acoustic neuroma in a 30° head up, left tilt, semi-prone position has just been concluded. The operation has lasted 8 h. There was no bleeding seen during the closure of the dura. The patient is a 55-year-old lady (200 lbs, 5.4 inches, ASA 2). She has a 3-year history of opiate use for osteoarthritis of her knees. A total of 20 mg of morphine IV has been given and the last dose of 2 mg was 90 min ago. The patient has had a total of 400 microgram of fentanyl which was given on induction. The isoflurane was turned off 20 min before the end of the surgery. The patient is allowed to wake up and the nitrous oxide and the remifentanil drip 0.5 microgram/kg /min are turned off. Unfortunately, there is no spontaneous breathing, and the patient is unresponsive with pinpoint pupils. She is still in the operating room intubated with assisted ventilation. Adding to your concern is the fact that the patient’s blood pressure, over a 20 min period, is now trending upward to 190/120 mmHg from 140/80 mmHg.