Multimodal Anesthetic Strategy to Facilitate Early Extubation in a Patient With Severe Restrictive Lung Disease Undergoing Major Scoliosis Surgery: A Case Report

Posterior scoliosis correction is associated with severe postoperative pain and substantial opioid requirements, which may pose a significant risk in patients with limited ventilatory reserve. We report the anesthetic management of a 20-year-old male with extremely severe scoliosis and very severe restrictive lung disease undergoing prolonged multilevel posterior spinal fusion with intraoperative neuromonitoring. A multimodal total intravenous anesthetic technique incorporating ketamine and lidocaine infusions was employed. This approach was associated with the preservation of neuromonitoring signals, successful end-of-case extubation in the operating room to supplemental oxygen via simple face mask, and low postoperative opioid requirements. This case highlights the importance of opioid minimization when managing high-risk patients with compromised pulmonary reserve.