Cervical Spine Injury with Self-Harm and Polysubstance Use

You are the anaesthetist on-call in a major trauma centre. The orthopaedic registrar has booked a 45-year-old woman for an urgent C3–C7 decompression and fusion for C5/6 bilateral facet joint fracture-dislocations. She has an incomplete spinal cord injury. The patient sustained the injury jumping off a cliff in an act of deliberate self-harm. She has had a prolonged extraction time due to difficult terrain. Past medical history anxiety and depression with multiple previous suicide attempts polysubstance use disorder with previous intravenous drug use Medications clonazepam 0.5–1.0 mg PRN for anxiety methadone 100mg mane quetiapine 300mg nocte