Complex Spine Surgery, Acute Spinal Cord Injury, and Autonomic Dysreflexia — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style complex spine surgery, acute spinal cord injury, and autonomic dysreflexia viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 28-year-old man falls from a palm tree and sustains a traumatic C4-C5 subluxation with flaccid quadriplegia and loss of sensation below the clavicles. In the trauma bay, his blood pressure is 78/42 mmHg, heart rate is 46 bpm, respiratory rate is 14 bpm (diaphragmatic breathing), and temperature is 35.2°C. Formulate your airway management, fluid resuscitation, and haemodynamic stabilization plan prior to urgent reduction and posterior cervical fusion.
• SCENARIO 2: A 16-year-old girl is undergoing a posterior spinal fusion from T3 to L2 for idiopathic scoliosis. During deformity correction rod rotation, the neuromonitoring team alerts you to an abrupt 85 percent drop in motor evoked potential (MEP) amplitude in both lower limbs. SSEP is also decreased. Outline your immediate, systematic anaesthetic checklist and corrective actions.
• SCENARIO 3: A 42-year-old male with a complete T4 spinal cord transection sustained 18 months ago presents for cystoscopy and removal of hardware. During the procedure under light general anaesthesia, his blood pressure surges abruptly to 230/130 mmHg, heart rate falls to 34 bpm, and profuse sweating and flushing appear on his face and neck. Describe your immediate diagnosis and step-by-step pharmacological management.
• SCENARIO 4: A 62-year-old woman with metastatic breast cancer to the lumbar spine (L1-L3) undergoes a 5-hour posterior decompression and instrumentation in the prone position. Intraoperative blood loss is 1200 mL, replaced with crystalloids and 2 units of packed red blood cells. On emergence, she complains of bilateral painless loss of vision. Detail the pathophysiological mechanism of postoperative visual loss (POVL), risk factors, and prevention.