Electrophysiological Neuromonitoring, Total Intravenous Anaesthesia (TIVA), and Pharmacological Neuroprotection — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style electrophysiological neuromonitoring, total intravenous anaesthesia (tiva), and pharmacological neuroprotection viva scenarios with examiner probes…

Scenarios covered

• SCENARIO 1: A 14-year-old boy is booked for corrective spinal instrumentation for severe neuromuscular scoliosis. The surgical team requires continuous Somatosensory Evoked Potential (SSEP) and Transcranial Motor Evoked Potential (TcMEP) monitoring. Describe your complete anaesthetic plan, including choice of intravenous and inhalational drugs, use of neuromuscular blocking agents, physiological parameter targets, and depth of anaesthesia monitoring.
• SCENARIO 2: You are administering a Total Intravenous Anaesthesia (TIVA) regimen using manual infusion pumps with propofol and fentanyl/remifentanil in a centre without Target-Controlled Infusion (TCI) pumps. Describe how you calculate loading and maintenance infusion rates, how you prevent intraoperative awareness, and how you monitor drug accumulation in prolonged neurosurgical cases.
• SCENARIO 3: During temporary occlusion of the parent vessel for a complex middle cerebral artery aneurysm, the neurosurgeon requests pharmacological neuroprotection and pharmacological burst suppression. Detail the pharmacokinetic and pharmacodynamic mechanisms, choice of agents (propofol vs thiopental), target EEG findings, and haemodynamic rescue strategy.
• SCENARIO 4: During resection of an intramedullary cervical spinal cord tumour under TIVA, the neuromonitoring technician announces that the SSEP amplitude has decreased by 60 percent and the latency has increased by 15 percent in both tibial nerve channels. Detail your systematic, step-by-step troubleshooting protocol to differentiate physiological/anaesthetic causes from surgical injury.