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Case report
Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion
  1. Evangeline Ko Villa1,
  2. Dominic Villa1 and
  3. Rafael C Bundoc2
  1. 1Department of Anesthesiology Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2Department of Orthopedics Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Evangeline Ko Villa; vangiekomd{at}


A 9-year-old female with Trisomy 21 with complex craniovertebral instability causing severe cervicomedullary compression underwent occipitocervical fusion. This paper will discuss the anaesthetic management and highlight the use of the Narcotrend monitor not only as a depth of consciousness monitor but more importantly as a tool to detect surgery-induced cerebral hypoperfusion by monitoring the right and left cerebral hemispheres independently and simultaneously.

  • healthcare improvement and patient safety
  • anaesthesia
  • orthopaedic and trauma surgery

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  • Contributors The main author (EKV) consolidated all the data, created the first draft and created the final manuscript after being critically perused by the coauthor. The coauthor (DV and RB) actively contributed in acquiring the data (details regarding patient’s case profile, perioperative care), conceptualising the outline of the discussion as well as participated in revising the manuscript critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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