{"id":10814,"date":"2026-01-09T07:25:02","date_gmt":"2026-01-09T07:25:02","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=10814"},"modified":"2026-01-09T07:25:24","modified_gmt":"2026-01-09T07:25:24","slug":"anaesthetic-management-of-c1-c2-schwannoma-under-general-anesthesia-using-remifentanil-and-rocuronium","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-january-2026\/anaesthetic-management-of-c1-c2-schwannoma-under-general-anesthesia-using-remifentanil-and-rocuronium\/","title":{"rendered":"Anaesthetic Management of C1\u2013C2 Schwannoma Under General anesthesia Using Remifentanil and Rocuronium"},"content":{"rendered":"

[vc_section][vc_row][vc_column][vc_column_text]<\/p>\n

A Case Report<\/h2>\n

Introduction:<\/h2>\n

Tumours involving the upper cervical spine are uncommon and present unique anaesthetic considerations. Any movement of the neck during airway manipulation may worsen spinal cord compression, and fluctuations in blood pressure can compromise spinal cord perfusion. Anaesthetic techniques that provide stable haemodynamics, excellent intubating conditions, and rapid recovery are therefore desirable. Short-acting opioids such as remifentanil and non-depolarising neuromuscular blocking agents like rocuronium, particularly when used as an infusion with reliable reversal, are well suited for such procedures.<\/p>\n

Case Presentation:<\/h2>\n

A 50-year-old male, known to have type 2 diabetes mellitus and hypertension, presented with neck pain and gradually progressive weakness of the right upper limb. Neurological examination revealed reduced power of 4\/5 in the right upper limb, with no other focal deficits. Magnetic resonance imaging of the cervical spine demonstrated a schwannoma at the C1\u2013C2 level, and surgical excision was planned. Pre-anaesthetic evaluation classified the patient as ASA physical status II, with a Mallampati grade III airway. Baseline vital signs and laboratory investigations were within acceptable limits, and blood glucose levels were optimised prior to surgery.<\/p>\n

Anaesthetic Management:<\/h2>\n

After instituting standard monitoring, the patient was pre-oxygenated with 100% oxygen. Anaesthesia was induced with intravenous remifentanil given as a bolus of 0.5\u20131 \u00b5g\/kg followed by an infusion at 0.05\u20130.2 \u00b5g\/kg\/min, along with propofol at a dose of 1.5\u20132 mg\/kg titrated to loss of consciousness. Neuromuscular blockade was achieved with rocuronium 0.6\u20131 mg\/kg to facilitate endotracheal intubation. Tracheal intubation was performed using a video laryngoscope while maintaining the cervical spine in a neutral position, and the procedure was smooth and atraumatic.<\/p>\n

Anaesthesia was maintained with an oxygen\u2013air mixture and sevoflurane at a minimum alveolar concentration of 0.8\u20131.0. Analgesia was continued with remifentanil infusion at 0.05-0.1 \u00b5g\/kg\/min and neuromuscular blockade was maintained using a rocuronium infusion at 5\u201310 \u00b5g\/kg\/min, titrated to neuromuscular monitoring. Controlled ventilation was used to maintain normocapnia throughout the surgery.<\/p>\n

Intra-operative Course:<\/h2>\n

The intra-operative period remained stable, with no significant fluctuations in heart rate or blood pressure. The estimated blood loss was approximately 500 ml and was managed appropriately with intravenous fluids. No intra-operative complications were encountered.<\/p>\n

Emergence and Post-operative Course:<\/h2>\n

At the end of the procedure, sevoflurane and remifentanil infusion were discontinued. After confirmation of moderate neuromuscular blockade, reversal was achieved using sugammadex at a dose of 2 mg\/kg. The patient was extubated awake with intact airway reflexes. Post-operative neurological assessment showed no worsening of the pre-existing right upper limb weakness. The post-operative period was uneventful.<\/p>\n

Advantages of Remifentanil in this Case:<\/h2>\n

Remifentanil was advantageous due to,<\/p>\n