Desflurane Anesthesia and Intraoperative Motor Evoked Potential Monitoring of a Patient with Cervical Cavernous Hemangioma Complicated with Liver Cirrhosis

: We report a 64-year-old man with cervical cavern- ous hemangioma. He had liver cirrhosis caused by non- alcoholic steatohepatitis (NASH) with stage C of Child- Pugh classification. Neurosurgeon requested transcra- nial myogenic motor evoked potential (MEP) monitor- ing to prevent postoperative neurological deterioration. We carried out anesthetic management and intraoper- ative myogenic MEP monitoring by desflurane and remifentanil. Intraoperative MEP monitoring is com- monly conducted under total intravenous anesthesia (TIVA). Propofol and remifentanil are routinely used anesthetics. For this patient, it was difficult to use pro- pofol because of severe liver dysfunction. Therefore, we used desflurane at 0.6 MAC (minimum alveolar con- centration) this time. Though there was slight ampli- tude decrement, it was possible to monitor MEP. After the operation, we extubated the patient in about 7 minutes and could confirm neurological functions immediately. Desflurane is beneficial to prevent aggra- vation of the liver function and to produce rapid awak- ening from anesthesia.