Propofol and Ketamine for Targeted Muscle Reinnervation after Limb Amputation: A Case Report
Surgical procedures that require neuromuscular monitoring
present unique challenges to the anesthesia provider. Specific
patient characteristics such as phantom limb pain or chronic
opioid use can further complicate perioperative management. The
following case presentation illustrates the anesthetic management
of a patient exhibiting these complications who presented for
surgery with a prior transhumeral amputation. Nerve reassignment
was planned with the eventual goal of a thought-controlled
prosthesis. Anesthesia was maintained by the combination of
propofol and ketamine along with adjuncts such as hydromorphone,
midazolam and glycopyrrolate. These drugs and similar
anesthetic combinations cause minimal changes to neurophysiologic
monitoring while decreasing various types of neuropathic
pain and provide an effective alternative for treating patients with
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