This chapter presents a case study of a 56-year-old male, American Society of Anesthesiologists Class III, scheduled to undergo T9-T12 laminectomy and microsurgical correction of a T10-T12 dural ateriovenous fistula. Central nervous system (CNS) function was monitored using somatosensory evoked potentials (SSEP), electromyography (EMG) and transcranial motor evoked potentials (MEP). The neurophysiologic monitors used in this case were monitors of CNS function, and can be described as follows: sensory evoked potentials (SEPs); motor evoked potentials; electromyography; and intraoperative changes. Sensory evoked potentials (SEPs) are measured electrophysiologic responses to somatosensory, visual, or auditory stimulation. Electromyography consists of monitoring muscle activity in response to either spontaneous or active nerve stimulation. In the immediate postoperative period a brief neurologic exam completed by the anesthetic team should be documented in the anesthetic record. In these ways morbidity and mortality in complex spine surgery using neurophysiologic monitoring can be reduced.

Jehovah's Witness (JW) is an evangelical Christian denomination best known to physicians for beliefs regarding the refusal of all blood product transfusions. This chapter presents a case study of a 54-year-old female with a history of obstructive sleep apnea, hyperlipidemia, and scoliosis who presented for T10-L5 posterior spinal fusion. The arterial blood gas analysis was used not only to assess respiratory and metabolic state but also the hematocrit. The antifibrinolytic drug aminocaproic acid was infused during the case to reduce blood loss. Erythropoietin is a blood-stimulating hormone normally synthesized in the kidney that stimulates red blood cell production in the bone marrow. While complex spine procedures in the JW patient may be challenging, successful outcomes can be achieved. With active preoperative assessment, communication, blood conservation strategies, proper positioning and meticulous surgical and anesthetic technique, complex spine surgeries are possible in the JW population.