What is a “wake-up” test?

What is a “wake-up” test?

The “wake-up” test is the classic means of assessing motor function in the intraoperative and immediate postoperative period. Essentially it entails decreasing the anesthetic to a plane where the patient can respond to simple commands (“Move your toes”, “Squeeze my fingers”). This demon-strates that the patient is without motor deficit from the procedure. It is considered the best way to assess the integrity of the spinal anterior motor tracts during spinal surgery. The anesthetic is then resumed for surgical completion or reversal of instrumentation. This monitoring technique has proven very effective in preventing postoperative paraplegia.

If a “wake-up” test is planned during the anesthetic regimen, the patient should be informed in advance of what to expect. Typically an opioid-based anesthetic with nitrous oxide and low-dose inhalational agent is utilized. The patient should be reassured that he or she will be comfortable for the procedure and unlikely to remember it. It is important to awaken the patient carefully and slowly to avoid inadvertent endotracheal extubation or injury with an overzealous response. This test is particularly useful in cases such as Harrington rod placement where the spinal cord is manipulated.