To explore the effects of dexmedetomidine on maintaining the normal breathing and circulatory functions during pediatric tethered cord syndrome (TCS) surgery with general anesthesia maintenance.

On September 25, 2018, a child with TCS and discovery of sacrococcygeal mass for 3⁺ months who underwent surgical treatment with dexmedetomidine for anesthesia maintenance in West China Hospital of Sichuan University was selected as research subject. A retrospective analysis was conducted to collect the clinical data of the patient, summarize the anesthesia maintenance plan during operation and its effects. When reviewing literatures related to anesthesia maintenance in pediatric TCS surgery, the strategies of literature retrieval were set as follows. With the keywords of " tethered cord syndrome" " pediatric" and " anesthesia" both in Chinese and English, literatures related to anesthesia maintenance of pediatric TCS surgery were searched from PubMed database, EMBASE database, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform and VIP database. The retrieval time was set from January 1, 2007 to October 1, 2018. The procedure followed in this study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①Medical history collection and auxiliary examination results: this child was male, 3⁺ months old, with discovery of sacrococcygeal mass 3⁺ months and without other abnormal development. The results of MRI showed that his sacral canal was enlarged and spindle fat signal was found in the posterior part of the sacral canal from L4 to S3 planes, which was about 4.0 cm × 1.2 cm × 1.3 cm. ②Surgical treatment: this child with TCS received the treatment of spinal cord adhesiolysis and resection of giant space occupying both inside and outside the spinal canal. Intraoperative neurophysiological monitoring (IONM) technique was used during the operation to monitor the motor evoked potential (MEP) and electromyogram of the child. ③Anesthesia induction and maintenance methods: inhalation of 8% sevoflurane by tidal volume method and intravenous injection of 5 μg sufentanil and 2 mg cisatracurium was used as anesthesia induction plan. Intravenous injection of dexmedetomidine 0.5-1.0 μg/(kg·min) combined with remifentanil 0.15-0.20 μg/(kg·min) was used as anesthesia maintenance plan for pediatric TCS operation. The duration of anesthesia maintenance was 5.1 h. No symptoms such as hypotension and heart rate decrease occurred after operation. Tracheas were successfully extubated, and the child discharged from hospital on the fourth day after operation. ④The results of literatures review were as follows. A total of 5 articles related to anesthesia maintenance for pediatric TCS operation were retrieved, involving 277 children with TCS. During the operation, intravenous injection of propofol, or inhalation of isoflurane, or the combination of these two were used as anesthesia maintenance plans for pediatric TCS operation. During the operation, except for one literature reported that 27 children were monitored by IONM technology, the rest were not monitored by IONM technology, and the duration of anesthesia maintenance was short, ranging from 50 to 260 min.

For pediatric TCS operation with the need of continuous use of IONM and long operation duration, dexmedetomidine can be used for anesthesia maintenance, but sufentanil and remifentanil should be combined to achieve ideal state of anesthesia maintenance. However, the dose of dexmedetomidine for anesthesia maintenance of pediatric TCS surgery still needs to be further confirmed by large-sample and long-term prognostic follow-up clinical studies.