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Lee NJ, Lenke LG, Yeary M, Dionne A, Nnake C, Fields M, Simhon M, Shi T, Arvind V, Ferraro A, Cooney M, Lewerenz E, Reyes JL, Roth S, Hung CW, Scheer JK, Zervos T, Thuet ED, Lombardi JM, Sardar ZM, Lehman RA, Hassan FM. Does an improvement in cord-level intraoperative neuromonitoring data lead to a reduced risk for postoperative neurologic deficit in spine deformity surgery? Spine Deform 2024:10.1007/s43390-024-00944-6. [PMID: 39117941 DOI: 10.1007/s43390-024-00944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE To determine if an improvement in cord-level intraoperative neuromonitoring (IONM) data following data loss results in a reduced risk for new postoperative motor deficit in pediatric and adult spinal deformity surgery. METHODS A consecutive series of 1106 patients underwent spine surgery from 2015 to 2023 by a single surgeon. Cord alerts were defined by Somatosensory-Evoked Potentials (SSEP; warning criteria: 10% increase in latency or > 50% loss in amplitude) and Motor-Evoked Potentials (MEP; warning criteria: 75% loss in amplitude without return to acceptable limits after stimulation up 100 V above baseline level). Timing of IONM loss and recovery, interventions, and baseline/postoperative day 1 (POD1) lower extremity motor scores were analyzed. RESULTS IONM Cord loss was noted in 4.8% (53/11,06) of patients and 34% (18/53) with cord alerts had a POD1 deficit compared to preoperative motor exam. MEP and SSEP loss attributed to 98.1% (52/53) and 39.6% (21/53) of cord alerts, respectively. Abnormal descending neurogenic-evoked potential (DNEP) was seen in 85.7% (12/14) and detected 91.7% (11/12) with POD1 deficit. Abnormal wake-up test (WUT) was seen in 38.5% (5/13) and detected 100% (5/5) with POD1 deficit. Most cord alerts occurred during a three-column osteotomy (N = 23/53, 43%); decompression (N = 12), compression (N = 7), exposure (N = 4), and rod placement (N = 14). Interventions were performed in all 53 patients with cord loss and included removing rods/less correction (N = 11), increasing mean arterial pressure alone (N = 10), and further decompression with three-column osteotomy (N = 9). After intervention, IONM data improved in 45(84.9%) patients (Full improvement: N = 28; Partial improvement: 17). For those with full and partial IONM improvement, the POD1 deficit was 10.7% (3/28) and 41.2% (7/17), respectively. For those without any IONM improvement (15.1%, 8/53), 100% (8/8) had a POD1 deficit, P < 0.001. CONCLUSION A full or partial improvement in IONM data loss after intraoperative intervention was significantly associated with a lower risk for POD1 deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. All patients without IONM improvement had a POD1 neurologic deficit.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Mitchell Yeary
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alexandra Dionne
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Chidebelum Nnake
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michael Fields
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Matthew Simhon
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Ted Shi
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Varun Arvind
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Anastasia Ferraro
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Matthew Cooney
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Erik Lewerenz
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Steven Roth
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Chun Wai Hung
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Justin K Scheer
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Thomas Zervos
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
| | - Earl D Thuet
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA
- The Och Spine Hospital, New York-Presbyterian, New York, NY, USA
| | - Fthimnir M Hassan
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Daniel and Jane Och Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY, 10034, USA.
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Kurita S, Furutani K, Mitsuma Y, Deguchi H, Kamoda T, Kamiya Y, Baba H. Effect of Remimazolam on Transcranial Electrical Motor-evoked Potential in Spine Surgery: A Prospective, Preliminary, Dose-escalation Study. J Neurosurg Anesthesiol 2024:00008506-990000000-00118. [PMID: 39037210 DOI: 10.1097/ana.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Some anesthetic drugs reduce the amplitude of transcranial electrical motor-evoked potentials (MEPs). Remimazolam, a new benzodiazepine, has been suggested to have little effect on MEP amplitude. This prospective, preliminary, dose-escalation study aimed to assess whether remimazolam is associated with lower MEP amplitude in a dose-dependent manner. METHODS Ten adult patients scheduled for posterior spinal fusion were included in this study. General anesthesia was induced with a continuous infusion of remifentanil and remimazolam. After the patient lost consciousness, the infusion rate of remimazolam was set to 1 mg/kg/h, and the patient underwent tracheal intubation. Baseline MEPs were recorded under 1 mg/kg/h of remimazolam in a prone position. Thereafter, the infusion rate of remimazolam was increased to 2 mg/kg/h, with a bolus of 0.1 mg/kg. Ten minutes after the increment, the evoked potentials were then recorded again. The primary endpoint was the MEP amplitude recorded in the left gastrocnemius muscle at 2 time points. RESULTS There was no difference in MEP amplitude recorded from the left gastrocnemius muscle before and after increasing remimazolam (median [interquartile range]: 0.93 [0.65 to 1.25] mV and 0.70 [0.43 to 1.26] mV, respectively; P=0.08). The average time from the cessation of remimazolam administration to neurological examination after surgery was 4 minutes using flumazenil. CONCLUSIONS This preliminary study suggests that increasing remimazolam from 1 to 2 mg/kg/h might have an insignificant effect on transcranial electric MEPs.
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Affiliation(s)
- Shuichiro Kurita
- Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata
| | - Kenta Furutani
- Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata
| | - Yusuke Mitsuma
- Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata
| | - Hiroyuki Deguchi
- Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata
| | - Tomoaki Kamoda
- Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata
| | - Yoshinori Kamiya
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Baba
- Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata
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Kim J, Lee S, Park B, Sim WS, Ahn HJ, Park MH, Jeong JS. Effect of remimazolam versus propofol anesthesia on postoperative delirium in neurovascular surgery: study protocol for a randomized controlled, non-inferiority trial. Perioper Med (Lond) 2024; 13:56. [PMID: 38877533 PMCID: PMC11177377 DOI: 10.1186/s13741-024-00415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/09/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Remimazolam is a short-acting benzodiazepine newly approved for the induction and maintenance of general anesthesia. Remimazolam emerges as an ideal drug for the neurosurgical population due to its rapid emergence, enabling early neurological assessment, and its ability to maintain perfusion pressure, which is crucial for preventing cerebral ischemia. However, the use of benzodiazepine has been associated with an increased risk of postoperative delirium (POD). There is currently limited evidence about the relationship between remimazolam-based total intravenous anesthesia (TIVA) and POD. METHODS In this double-blind, randomized, non-inferiority trial, we plan to include 696 adult patients with American Society of Anesthesiologists physical status class I to III, undergoing elective neurovascular surgery under general anesthesia. After informed consent, the patients will be randomized to receive either remimazolam or propofol-based TIVA with a 1:1 ratio. The primary outcome is the incidence of POD within 5 days after surgery. Secondary outcomes include subtypes, number of positive assessments and severity of POD, emergence agitation, intraoperative awareness and undesirable patient movement, intraoperative hypotension, and postoperative cognitive function. The data will be analyzed in modified intention to treat. DISCUSSION This trial will evaluate the effect of remimazolam on the development of POD compared to propofol anesthesia. The results of this trial will provide evidence regarding the choice of optimal anesthetics to minimize the risk of POD in neurosurgical patients. TRIAL REGISTRATION The study protocol was prospectively registered at the Clinical trials ( https://clinicaltrials.gov , NCT06115031, principal investigator: Jiseon Jeong; date of first registration: November 2, 2023, before the recruitment of the first participant.
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Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Hye Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Murakami T, Tanaka S, Tanaka R, Ito M, Ishida T, Kawamata M. Second-degree atrioventricular block induced by electrical stimulation of transcranial motor-evoked potential: a case report. JA Clin Rep 2024; 10:38. [PMID: 38862743 PMCID: PMC11166606 DOI: 10.1186/s40981-024-00722-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Although several complications of transcranial motor-evoked potentials (Tc-MEPs) have been reported, reports of arrhythmias during Tc-MEP are very rare. CASE PRESENTATION A 71-year-old woman underwent transforaminal lumbar interbody fusion under general anesthesia, with intraoperative Tc-MEP monitoring. Preoperative electrocardiography showed an incomplete right bundle branch block but no cardiovascular events in her life. After induction of anesthesia, Tc-MEP was recorded prior to the surgery. During the Tc-MEP monitoring, electrocardiography and arterial blood pressure showed a second-degree atrioventricular block, but it improved rapidly at the end of the stimulation, and the patient was hemodynamically stable. Tc-MEP was recorded seven times during surgery; the incidence of P waves without QRS complexes was significantly higher than before stimulation. The surgery was uneventful, and she was discharged eight days postoperatively without complications. CONCLUSIONS Our case suggests that electrical stimulation for Tc-MEP can cause arrhythmia. Electrocardiography and blood pressure must be closely monitored during Tc-MEP monitoring.
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Affiliation(s)
- Toru Murakami
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ryusuke Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Mariko Ito
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takashi Ishida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Deng Y, Chen J, Liu ZX, Yang J, Huang Z, Yang J, Sui W. Descending Neurogenic Evoked Potentials Monitoring Is an Effective Alternative in Spinal Deformity Surgery Under Inhaled Anesthesia. World Neurosurg 2024; 184:e17-e24. [PMID: 38070738 DOI: 10.1016/j.wneu.2023.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND To evaluate the reliability of descending neurogenic evoked potentials (DNEP) monitoring in spinal deformity surgery under inhaled anesthesia. METHODS A total of 180 consecutive patients who underwent spinal deformity surgery in our scoliosis center from July 2014 to August 2016 were reviewed. Intraoperative monitoring including somatosensory evoked potentials (SEP), motor evoked potentials (MEP), and DNEP was conducted routinely throughout operation. Patients were divided into 2 groups according to anesthesia methods: group A (n = 72, inhaled anesthesia, SEP/DNEP) and group B (n = 108, total intravenous anesthesia, SEP/MEP/DNEP). Intraoperative monitoring data were collected and analyzed. RESULTS Positive alerts were observed in 26 patients (14.5%), of whom 18 (10%) were confirmed as true-positive events in the study population. No false-negative events were recorded. In group A, the sensitivity and specificity of SEP and DNEP were 100% and 93.8% and 100% and 98.5%, respectively. For group B, the sensitivity and specificity of SEP/MEP and DNEP were 100% and 95.9% and 100% and 98%, respectively. CONCLUSIONS DNEP monitoring seemed to be effective for the detection and prevention of iatrogenic neurologic deficits during spinal deformity surgery. This study indicates that DNEP was an effective alternative in spinal deformity surgery under inhaled anesthesia.
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Affiliation(s)
- Yaolong Deng
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Chen
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zi-Xiang Liu
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingfan Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zifang Huang
- Department of Orthopaedic Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Abdelaal Ahmed Mahmoud Metwally Alkhatip A, Mills KE, Hogue O, Sallam A, Hamza MK, Farag E, Yassin HM, Wagih M, Ahmed AMI, Helmy MH, Elayashy M. The effects of dexmedetomidine on intraoperative neurophysiologic monitoring modalities during corrective scoliosis surgery in pediatric patients: A systematic review. Paediatr Anaesth 2024; 34:112-120. [PMID: 37927199 DOI: 10.1111/pan.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND During scoliosis surgery, motor evoked potentials (MEP), and somatosensory evoked potentials (SSEP) have been reported to be affected by the use of higher doses of anesthetic agents. Dexmedetomidine, a sympatholytic agent, an alpha-2 receptor agonist, has been used as an adjunctive agent to lower anesthetic dose. However, there is conflicting evidence regarding the effects of dexmedetomidine on the intraoperative neurophysiological monitoring of MEP and SSEP during surgery, particularly among pediatric patients. OBJECTIVES This systematic review aimed to determine whether, during spinal fusion surgery in pediatric patients with scoliosis, dexmedetomidine alters MEP amplitude or SSEP latency and amplitude and, if so, whether different doses of dexmedetomidine display different effects (PROSPERO registration number CRD42022300562). METHODS We searched PubMed, Scopus, and Cochrane Library on January 1, 2022 and included randomized controlled trials, observational cohort and case-control studies and case series investigating dexmedetomidine in the population of interest and comparing against a standardized anesthesia regimen without dexmedetomidine or comparing multiple doses of dexmedetomidine. Animal and in vitro studies and conference abstracts were excluded. RESULTS We found substantial heterogeneity in the risk of bias (per Cochrane-preferred tools) of the included articles (n = 5); results are summarized without meta-analysis. Articles with the lowest risk of bias indicated that dexmedetomidine was associated with MEP loss and that higher doses of dexmedetomidine increased risk. In contrast, articles reporting no association between dexmedetomidine and MEP loss suffered from higher risk of bias, including suspected or confirmed problems with confounding, outcome measurement, participant selection, results reporting, and lack of statistical transparency and power. CONCLUSION Given the limitations of the studies available in the literature, it would be advisable to conduct rigorous randomized controlled trials with larger sample sizes to assess the effects of dexmedetomidine use of in scoliosis surgery in pediatric patients.
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Affiliation(s)
| | | | - Olivia Hogue
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Sallam
- Department of Anaesthesia, Tallaght University Hospital, Dublin, Ireland
| | | | - Ehab Farag
- Department of Anaesthesia, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Hany Mahmoud Yassin
- Department of Anaesthesia, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed Wagih
- Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mohamed Elayashy
- Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
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7
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Gamble JJ, Goobie SM. Dexmedetomidine and neurophysiologic monitoring-A call for evidence to guide contemporary best practice for pediatric anesthesiologists. Paediatr Anaesth 2024; 34:101-103. [PMID: 37983954 DOI: 10.1111/pan.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Jonathan J Gamble
- Department of Anesthesia, Perioperative Medicine, and Pain Management, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Susan M Goobie
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Venugopal Menon K, Basu S, Oka G, Gohil K. Delphi-Based Survey for Surgical Indications in Biopsy Proven Active Adult Spinal Tuberculosis. Global Spine J 2023:21925682231204157. [PMID: 37776140 DOI: 10.1177/21925682231204157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
STUDY DESIGN Delphi survey. OBJECTIVES To obtain an expert consensus on various dilemmas in the surgical treatment of adult spinal tuberculosis (TB) patients. METHODS Stage I included a literature review, stage II the identification of 40 Key Opinion leaders (KOLs) and a set of 46 questions, stage III included analysis of 3 rounds of the Delphi survey, and stage IV had final analysis and recommendations. For each question, the level of agreement needed to reach a consensus was set at greater than or equal to 70.0%. RESULTS The first and second Delphi survey rounds received 62 and 58 responses, respectively, with 16 questions having more than 70% and two questions having 100% agreement in the first stage. The second stage saw a 70% agreement on six questions. Thus, a consensus was obtained on 22 questions. The recommendations that emerged were as follows: neurodeficit with corresponding radiology and neurological deficit appearing/deteriorating while on anti-tubercular chemotherapy(ATT) are absolute indications for surgery, duration of ATT before neurological deterioration need not be considered, epidural abscess does not need decompression unless concordant clinical neurological findings are present, pain not responding to medical management is not a surgical indication, active pulmonary TB, drug-resistant TB, and tubercular sacroiliitis are not considered as surgical indications, and hemoglobin and other health markers have little contribution to surgical indications. CONCLUSION In order to resolve several conundrums in the surgical treatment of adult spinal TB, this Delphi survey is the first to achieve a national consensus from spine experts. The final recommendations cover the serological, radiographic, and clinical aspects of spinal TB.
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Affiliation(s)
- K Venugopal Menon
- Department of Orthopedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Saumyajit Basu
- Head of Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Gauri Oka
- Research Consultant, Central Research and Publication Unit, Bharati Vidyapeeth Medical College and Hospital, Pune, India
| | - Kushal Gohil
- Department of Orthopedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
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9
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Jian M, Liu H, Liang F, Ma B, Wang L, Zhou Y, Qiao H, Han R, Wang C. Effect of intraoperative muscle relaxation reversal on the success rate of motor evoked potential recording in patients undergoing spinal surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:290. [PMID: 37626303 PMCID: PMC10464330 DOI: 10.1186/s12871-023-02211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Partial neuromuscular blockade (NMB) has been applied for some surgeries to reduce bleeding and prevent patient movement for spinal surgery. Sugammadex selectively binds to rocuronium in the plasma and consequently lowers the rocuronium concentration at the neuromuscular junction. In this study, we aimed to observe whether the success rate of transcranial motor-evoked potential (TceMEP) can be increased by sugammadex compared with partial NMB during spinal surgery. METHODS Patients who underwent elective spinal surgery with TceMEP monitoring were randomly assigned to the sugammadex group and control group. Rocuronium was continuously infused to maintain the train of four counts (TOFc) = 2. The sugammadex group discontinued rocuronium infusion at the time of TceMEP monitoring and was infused with 2 mg/kg sugammadex; the control group was infused with the same dose of saline. RESULTS A total of 171 patients were included. The success rate of TceMEP monitoring in the sugammadex group was significantly higher than that in the control group. TceMEP amplitudes were greater in the sugammadex group than in the control group at 5 min, 10 min, and 20 min after the start of motor-evoked potential monitoring. The latencies of upper extremity TceMEPs monitoring showed no difference between groups. TOF ratios were greater in the sugammadex group at 5 min, 10 min, and 20 min after the start of motor-evoked potential monitoring. There were no adverse effects caused by sugammadex. CONCLUSIONS Sugammadex can improve the success rate of motor-evoked potential monitoring compared with moderate neuromuscular blockade induced by continuous infusion of rocuronium in spinal surgery. TRIAL REGISTRATION The study was registered on clinicaltrials.gov.cn on 29/10/2020 (trial registration number: NCT04608682).
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Affiliation(s)
- Minyu Jian
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Haiyang Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Fa Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Bo Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Lianjie Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
- Department of Anesthesiology, Beijing Fangshan Liangxiang Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Hui Qiao
- Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China.
| | - Chengwei Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China.
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Liu H, Jian M, Wang C, Nie L, Liang F, Liu K, Zhang K, Qiao H, Han R. Effect of Sugammadex During Transcranial Electrical Motor Evoked Potentials Monitoring in Spinal Surgery: A Randomized Controlled Trial. J Neurosurg Anesthesiol 2023; 35:224-231. [PMID: 34839318 DOI: 10.1097/ana.0000000000000820] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Neuromuscular blockade suppresses transcranial electrical motor evoked potential (TceMEP) amplitude and is usually avoided during TceMEP monitoring. In this randomized controlled trial, we investigated whether rocuronium-induced suppression of TceMEP amplitude could be reversed by sugammadex in patients undergoing spine surgery. METHODS Seventy-six patients undergoing spinal surgery were randomly allocated into sugammadex and control groups. In the sugammadex group, a rocuronium infusion was titrated to maintain moderate neuromuscular blockade (2 twitches on train-of-four) until dural opening when the rocuronium infusion was discontinued and 2 mg/kg sugammadex administered. In the control group, no neuromuscular blockade was administered after induction of anesthesia. The primary outcome was a comparison between sugammadex and control groups of mean TceMEP amplitudes in the abductor pollicis brevis muscles of both upper extremities 5 minutes after dural. Secondary outcomes included TceMEP amplitudes at 10, 20, 30, and 60 minutes after dural opening. RESULTS Sixty-six patients were included in the analysis. TceMEP amplitudes were significantly greater in the sugammadex group (629 μV, interquartile range: 987 μV) than in the control group (502 μV, interquartile range: 577 μV; P =0.033) at 5 minutes after dural opening. TceMEP amplitudes were also greater in the sugammadex group at 10 minutes ( P =0.0010), 20 minutes ( P =0.003), 30 minutes ( P =0.001), and 60 minutes ( P =0.003) after dural opening. CONCLUSIONS Moderate neuromuscular blockade induced by continuous infusion of rocuronium was effectively reversed by sugammadex. This suggests that sugammadex could be used to enhance TceMEP waveform monitoring during spine surgery requiring muscle relaxation.
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Affiliation(s)
- Haiyang Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University
| | - Minyu Jian
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University
| | - Chengwei Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University
| | - Lanyi Nie
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University
| | - Fa Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University
| | - Kuo Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
| | - Kaiying Zhang
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hui Qiao
- Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University
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Joy JJ, Bidkar PU, Swaminathan S, Balasubramanian M, Dey A, Chinnarasan VC, Gunasekaran A. Comparison of Dexmedetomidine Versus Fentanyl-Based Anesthetic Protocols Under Patient State Index Guidance in Patients Undergoing Elective Neurosurgical Procedures with Intraoperative Neurophysiological Monitoring. Cureus 2023; 15:e35864. [PMID: 37033575 PMCID: PMC10078854 DOI: 10.7759/cureus.35864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Objectives The study was designed to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol in total intravenous anesthesia (TIVA) on anesthetic dose reduction, the quality of intraoperative neurophysiological monitoring (IONM) recordings, analgesic requirements, and recovery parameters in patients undergoing neurosurgical procedures with neurophysiological monitoring. Methods A total of 54 patients for elective neurosurgical procedures with IONM were randomized to group D (dexmedetomidine) and group F (fentanyl). A loading dose of the study drug of 1µg/kg followed by 0.5 µg/kg/h infusion was used in two groups. Propofol-based TIVA with a Schneider target-controlled infusion model was used for induction and maintenance with effect site concentration of 4-5 and 2.5-4 µg/mL, respectively, titrated to a Patient State Index (PSI) of 25-40. Baseline IONM recordings were obtained after induction. The mean propofol consumption, number of patient movements, quality of IONM recordings, number of fentanyl boluses, hemodynamic characteristics, and recovery parameters were recorded. Results The mean propofol consumption was significantly lower in group D when compared to group F (101.4 ± 13.5 µg/kg/min vs 148.0 ± 29.8 µg/kg/min). Baseline IONM recordings were acquired in all patients without any difficulty. The two groups were comparable with respect to the number of additional boluses of fentanyl, patient movements, and recovery characteristics. Conclusion Dexmedetomidine as an adjuvant to propofol in TIVA reduces the requirement of the latter, without affecting the IONM recordings. The addition of dexmedetomidine also ensures stable hemodynamics and decreases the requirement of opioids with similar recovery characteristics.
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Yamada S, Akiyama Y, Tachibana S, Hayamizu K, Kimura Y, Hashimoto S, Yamakage M, Mikuni N. The intraoperative motor-evoked potential when propofol was changed to remimazolam during general anesthesia: a case series. J Anesth 2023; 37:154-159. [PMID: 36319911 DOI: 10.1007/s00540-022-03112-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
Remimazolam is a short-acting benzodiazepine that was approved for clinical use in 2020. We report three patients who underwent surgery for cerebral and spinal cord tumors, in whom transcranial electrical stimulation-motor-evoked potential (TES-MEP) was successfully monitored under general anesthesia with remimazolam. During total intravenous anesthesia with propofol at a target concentration of 2.7 - 3.5 µg/mL and 0.1 - 0.35 µg/kg/min of remifentanil, delayed awakening, bradycardia, and hypotension during propofol anesthesia were expected in all three cases. With patient safety as the top priority, we considered changing the anesthetic agent. Propofol was replaced with remimazolam at a loading dose of 12 mg/kg/h for a few seconds (case 3), followed by 1 mg/kg/h for maintenance (cases 1-3). TES-MEP was recorded during propofol and remimazolam administration in all three patients. Amplitudes of TES-MEP during anesthesia with propofol and remimazolam were 461.5 ± 150 µV and 590.5 ± 100.9 µV, 1542 ± 127 µV and 1698 ± 211 µV, and 581.5 ± 91.3 µV and 634 ± 82.7 µV sequentially from Case 1. Our findings suggest that intraoperative TES-MEP could be measured when anesthesia was managed with remimazolam at 1 mg/kg/h.
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Affiliation(s)
- Shoto Yamada
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan.
| | - Shunsuke Tachibana
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Kengo Hayamizu
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Shuichi Hashimoto
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Michiaki Yamakage
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
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Jiang X, Tang X, Liu S, Liu L. Effects of dexmedetomidine on evoked potentials in spinal surgery under combined intravenous inhalation anesthesia: a randomized controlled trial. BMC Anesthesiol 2023; 23:36. [PMID: 36721105 PMCID: PMC9887773 DOI: 10.1186/s12871-023-01990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/18/2023] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We aimed to investigate the effects of different doses of dexmedetomidine (Dex) on evoked potentials in adult patients undergoing spinal surgery under intravenous anesthesia with low-concentration desflurane. METHODS Ninety patients were divided into three groups at random. To maintain anesthesia in the control group (group C), desflurane 0.3 MAC (minimal alveolar concentration), propofol, and remifentanil were administered. Dex (0.5 μg·kg-1) was injected for 10 min as a loading dose in the low-dose Dex group (group DL), then adjusted to 0.2 μg·kg-1·h-1 until the operation was completed. Dex (1 μg·kg-1) was injected for 10 min as a loading dose in the high-dose Dex group (group DH), then adjusted to 0.7 μg·kg-1·h-1 until the operation was completed. The additional medications were similar to those given to group C. The perioperative hemodynamics, body temperature, intraoperative drug dosages, fluid volume, urine volume, blood loss, the latency and amplitude of somatosensory evoked potentials (SEPs) at four different time points, the incidence of positive cases of SEPs and transcranial motor evoked potentials (tcMEPs), and perioperative adverse reactions were all recorded. RESULTS Data from 79 patients were analyzed. The MAP measured at points T2-T4 in group DH was higher than at corresponding points in group C (P < 0.05). The MAP at point T4 in group DL was higher than at corresponding points in group C (P < 0.05). The remifentanil dosage in group DH was significantly lower than in group C (P = 0.015). The fluid volume in group DL was significantly lower than in group C (P = 0.009). There were no significant differences among the three groups in the amplitude and latency of SEP at different time points, nor in the incidence of warning SEP signals. The incidence of positive tcMEP signals did not differ significantly between groups C and DL (P > 0.05), but was significantly higher in group DH than in groups DL (P < 0.05) or C (P < 0.05). The incidence of intraoperative hypertension was significantly higher in group DH than in group C (P = 0.017). CONCLUSIONS Low-dose Dex has no effect on the SEPs and tcMEPs monitoring during spinal surgery. High-dose Dex has no effect on SEPs monitoring, but it may increase the rate of false positive tcMEPs signals and the incidence of intraoperative hypertension. TRIAL REGISTRATION This study has completed the registration of the Chinese Clinical Trial Center at 11/09/2020 with the registration number ChiCTR2000038154.
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Affiliation(s)
- Xinyu Jiang
- grid.452206.70000 0004 1758 417XDepartment of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, 400016 People’s Republic of China
| | - Xiaoning Tang
- grid.452206.70000 0004 1758 417XDepartment of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, 400016 People’s Republic of China
| | - Shaoquan Liu
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Ling Liu
- grid.452206.70000 0004 1758 417XDepartment of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, 400016 People’s Republic of China
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Dastagirzada YM, Alexiades NG, Kurland DB, Anderson SN, Brockmeyer DL, Bumpass DB, Chatterjee S, Groves ML, Hankinson TC, Harter D, Hedequist D, Jea A, Leonard JR, Martin JE, Oetgen ME, Pahys J, Rozzelle C, Strahle JM, Thompson D, Yaszay B, Anderson RCE. Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study. J Neurosurg Pediatr 2023; 31:32-42. [PMID: 36308472 DOI: 10.3171/2022.9.peds22319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spine disorders in children are relatively uncommon; therefore, paradigms for surgical and nonsurgical clinical management are not well established. The purpose of this study was to bring together an international, multidisciplinary group of pediatric cervical spine experts to build consensus via a modified Delphi approach regarding the clinical management of children with cervical spine disorders and those undergoing cervical spine stabilization surgery. METHODS A modified Delphi method was used to identify consensus statements for the management of children with cervical spine disorders requiring stabilization. A survey of current practices, supplemented by a literature review, was electronically distributed to 17 neurosurgeons and orthopedic surgeons experienced with the clinical management of pediatric cervical spine disorders. Subsequently, 52 summary statements were formulated and distributed to the group. Statements that reached near consensus or that were of particular interest were then discussed during an in-person meeting to attain further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS Forty-five consensus-driven statements were identified, with all participants willing to incorporate them into their practice. For children with cervical spine disorders and/or stabilization, consensus statements were divided into the following categories: A) preoperative planning (12 statements); B) radiographic thresholds of instability (4); C) intraoperative/perioperative management (15); D) postoperative care (11); and E) nonoperative management (3). Several important statements reaching consensus included the following recommendations: 1) to obtain pre-positioning baseline signals with intraoperative neuromonitoring; 2) to use rigid instrumentation when technically feasible; 3) to provide postoperative external immobilization for 6-12 weeks with a rigid cervical collar rather than halo vest immobilization; and 4) to continue clinical postoperative follow-up at least until anatomical cervical spine maturity was reached. In addition, preoperative radiographic thresholds for instability that reached consensus included the following: 1) translational motion ≥ 5 mm at C1-2 (excluding patients with Down syndrome) or ≥ 4 mm in the subaxial spine; 2) dynamic angulation in the subaxial spine ≥ 10°; and 3) abnormal motion and T2 signal change on MRI seen at the same level. CONCLUSIONS In this study, the authors have demonstrated that a multidisciplinary, international group of pediatric cervical spine experts was able to reach consensus on 45 statements regarding the management of pediatric cervical spine disorders and stabilization. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.
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Affiliation(s)
- Yosef M Dastagirzada
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| | | | - David B Kurland
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| | | | - Douglas L Brockmeyer
- 4Department of Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah
| | - David B Bumpass
- 5Department of Orthopedic Surgery, University of Arkansas, Little Rock, Arkansas
| | | | - Mari L Groves
- 7Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd C Hankinson
- 8Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Harter
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
| | - Daniel Hedequist
- 9Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Jea
- 10Department of Neurological Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey R Leonard
- 11Department of Neurosurgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jonathan E Martin
- 12Division of Pediatric Neurosurgery, Connecticut Children's, Hartford, Connecticut
| | - Matthew E Oetgen
- 13Division of Orthopedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC
| | - Joshua Pahys
- 14Department of Pediatric Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Curtis Rozzelle
- 15Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Jennifer M Strahle
- 16Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Dominic Thompson
- 17Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom; and
| | - Burt Yaszay
- 18Department of Orthopedics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Richard C E Anderson
- 1Department of Neurological Surgery, New York University, Hassenfeld Children's Hospital, New York, New York
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15
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Liu M, Wang N, Wang D, Liu J, Zhou X, Jin W. Effect of low-dose lidocaine on MEPs in patients undergoing intracranial tumor resection with propofol anesthesia: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e29965. [PMID: 35960044 PMCID: PMC9371567 DOI: 10.1097/md.0000000000029965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To investigate the effect of low-dose lidocaine on motor evoked potentials (MEPs) in patients undergoing intracranial tumor resection with propofol anesthesia. METHODS Forty patients who underwent intracranial tumor resection and required MEP monitoring were selected. They were randomly divided into the lidocaine group (group L, n = 20) and the control group (group C, n = 20) by computer-generated randomization. All patients were given propofol anesthesia under the guidance of the bispectral index. In group L, 1 mg/kg of lidocaine was injected intravenously during anesthesia induction. Then, lidocaine was continuously pumped at a speed of 1 mg/kg/h until the operation started. Group C was given an equal volume of normal saline. Heart rate (HR), mean artery pressure (MAP), and bispectral index were recorded before anesthesia induction (T0), 2 minutes after tracheal intubation (T1), and 35 minutes (T2), and 50 minutes (T3) after anesthesia induction. The amplitude and latency of MEP at T2 and T3, the total dosage of propofol after anesthesia induction, and adverse events before T3 were recorded. RESULTS Compared with those in group C, HR and MAP were significantly decreased at T1 in group L. No significant differences were observed in HR and MAP at T0, T2, and T3 between group L and group C. The total dosage of propofol and the incidence of adverse events were significantly lower in group L than in group C before T3. There were no significant differences in the amplitude and latency of MEP between the 2 groups at each time point. CONCLUSIONS Low-dose lidocaine has no obvious effect on MEP in patients undergoing intracranial tumor resection. However, it increased hemodynamic stability, reduced propofol use, and decreased the incidence of adverse events.
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Affiliation(s)
- Meijuan Liu
- Department of Anesthesiology, Brain Hospital Affiliated to Nanjing Medical University, NanjingChina
| | - Ning Wang
- Department of Anesthesiology, Brain Hospital Affiliated to Nanjing Medical University, NanjingChina
| | - Dong Wang
- Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Juan Liu
- Department of Anesthesiology, Brain Hospital Affiliated to Nanjing Medical University, NanjingChina
| | - Xuelong Zhou
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenjie Jin
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Wenjie Jin, Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China (e-mail: )
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16
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Jian M, Ma B, Liu H, Wang C, Liang F, Zhou Y, Qiao H, Han R. Effect of intraoperative muscle relaxation reversal on the success rate of motor-evoked potential recording in patients undergoing spinal surgery: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e056571. [PMID: 35501072 PMCID: PMC9062813 DOI: 10.1136/bmjopen-2021-056571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/15/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Transcranial motor-evoked potentials (TceMEPs) is conventionally performed without neuromuscular blockade (NMB) because of its potential interference with neuromuscular junction and signal interpretation. Sugammadex is the first highly selective antagonist that binds to rocuronium and can rapidly and effectively reverse NMB. This study aims to evaluate the success rate of intraoperative muscle relax reversal by sugammadex on intraoperative TceMEP recording. METHODS AND ANALYSIS We will conduct a single-centre randomised controlled study. In total, 162 patients undergoing thoracic or lumbar spinal surgery will be randomly divided into the sugammadex group or control group at a ratio of 1:1. Total intravenous anaesthesia by propofol and remifentanil will be performed in both groups. In the sugammadex group, patients will receive continuous infusion of rocuronium to produce a blockade maintained for at least two twitches in train-of-four, rocuronium infusion will be discontinued and 2 mg/kg sugammadex will be given while performing TceMEPs monitoring. In the control group, rocuronium infusion will be discontinued and the same volume of saline will be infused while performing TceMEPs monitoring. The primary aim of this study is to evaluate the success rate of TceMEPs recording between two groups. ETHICS AND DISSEMINATION The approval for the study was certificated by the Ethical Committee of Beijing Tiantan Hospital, Capital Medical University on, 16 July 2021 (KY2021-082-02). The study was registered on clincaltrials.gov on 25 October 2020. Our study might guide neuromuscular blockade plans in TceMEPs monitoring undergoing spinal surgery. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conference. TRIAL REGISTRATION NUMBER NCT04608682.
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Affiliation(s)
- Minyu Jian
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Bo Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Haiyang Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Chengwei Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Fa Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Hui Qiao
- Department of Electrophysiology, Beijing Neurosurgical Institute, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
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17
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Liu T, Qin Y, Qi H, Luo Z, Yan L, Yu P, Dong B, Zhao S, Wu X, Chang Z, Liu Z, Liu X, Yuan T, Li H, Xiao L, Wang G. A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study. Front Pharmacol 2022; 13:840320. [PMID: 35330828 PMCID: PMC8940210 DOI: 10.3389/fphar.2022.840320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The effect of a bolus dose of dexmedetomidine on intraoperative neuromonitoring (IONM) parameters during spinal surgeries has been variably reported and remains a debated topic. Methods: A randomized, double-blinded, placebo-controlled study was performed to assess the effect of dexmedetomidine (1 μg/kg in 10 min) followed by a constant infusion rate on IONM during thoracic spinal decompression surgery (TSDS). A total of 165 patients were enrolled and randomized into three groups. One group received propofol- and remifentanil-based total intravenous anesthesia (TIVA) (T group), one group received TIVA combined with dexmedetomidine at a constant infusion rate (0.5 μg kg−1 h−1) (D1 group), and one group received TIVA combined with dexmedetomidine delivered in a loading dose (1 μg kg−1 in 10 min) followed by a constant infusion rate (0.5 μg kg−1 h−1) (D2 group). The IONM data recorded before test drug administration was defined as the baseline value. We aimed at comparing the parameters of IONM. Results: In the D2 group, within-group analysis showed suppressive effects on IONM parameters compared with baseline value after a bolus dose of dexmedetomidine. Furthermore, the D2 group also showed inhibitory effects on IONM recordings compared with both the D1 group and the T group, including a statistically significant decrease in SSEP amplitude and MEP amplitude, and an increase in SSEP latency. No significance was found in IONM parameters between the T group and the D1 group. Conclusion: Dexmedetomidine delivered in a loading dose can significantly inhibit IONM parameters in TSDS. Special attention should be paid to the timing of a bolus dose of dexmedetomidine under IONM. However, dexmedetomidine delivered at a constant speed does not exert inhibitory effects on IONM data.
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Affiliation(s)
- Tun Liu
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yue Qin
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Huaguang Qi
- Department of Functional Inspection Section, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhenguo Luo
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Liang Yan
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Pengfei Yu
- Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Buhuai Dong
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Songchuan Zhao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xucai Wu
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhen Chang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhian Liu
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xuemei Liu
- Department of Functional Inspection Section, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Yuan
- Department of Functional Inspection Section, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Houkun Li
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Li Xiao
- Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Gang Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
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Elkafrawy SA, Zayed ES, Mostafa KA, Kandeel IM, Mohammed AA, Hassan MM. The effect of propofol-based anesthesia versus low dose propofol with less than half MAC sevoflurane on intraoperative trans-cranial motor evoked potential during spine surgeries: Ratios rather than values. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2004030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Samir A. Elkafrawy
- Department of Anesthesiology, Neuroanesthesia Unit, ElSahel Teaching Hospital, GOTHI, Cairo, Egypt
| | - Eman S. Zayed
- Department of Anesthesiology, Neuroanesthesia Unit, ElSahel Teaching Hospital, GOTHI, Cairo, Egypt
| | - Khaled A Mostafa
- Department of Anesthesiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Islam M. Kandeel
- Department of Neurosurgery, ElSahel Teaching Hospital, GOTHI, Cairo, Egypt
| | - Ahmed A. Mohammed
- Department of Anesthesiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohammed M. Hassan
- Department of Anesthesiology, National Cancer Institute, Cairo University, Cairo, Egypt
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Wang Y, Zhao X, Geng B, Sheng X, Zhang K, Cao C, Xia Y, Chen S. Application of Triggered EMG in the Intraoperative Neurophysiological Monitoring of Posterior Percutaneous Endoscopic Cervical Discectomy. Orthop Surg 2021; 13:2236-2245. [PMID: 34668326 PMCID: PMC8654663 DOI: 10.1111/os.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To describe the rationale and application of triggered EMG (T-EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM). METHODS This study was a retrospective cohort control study. The clinical data of 74 patients with single-segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM-assisted PPECD with triggered EMG (T-EMG group), while 39 were subjected to IOM-assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale. RESULTS Operations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow-up. No significant difference was found in preoperative baseline data between the T-EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T-EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T-EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P < 0.05). The VAS for the neck and upper limbs in the two groups at 1 month post-operation (T-EMG: 2.09 ± 1.07, 2.26 ± 0.92; IOM:2.18 ± 1.05, 2.31 ± 0.77) and the last follow-up (T-EMG: 0.83 ± 0.62, 0.86 ± 0.55; IOM: 0.90 ± 0.50, 0.87 ± 0.61) were significantly different from the preoperative scores (T-EMG: 6.14 ± 1.09, 7.17 ± 1.04; IOM: 6.18 ± 1.28, 7.15 ± 1.23) (P < 0.05). However, no significant difference was found between the two groups (P > 0.05). The 1-month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow-up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P < 0.05), but the difference between the two groups was not significant (P > 0.05). One patient in the T-EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T-EMG group had fewer complications (1/35; 7/39, P < 0.05). At the last follow-up, the modified MacNab criteria were 91.43% (32/35) and 89.7% (35/39) for the T-EMG group and IOM group, respectively. CONCLUSIONS Triggered EMG prevents the occurrence of neurological complications, which not only aids PPECD for CSR treatment in achieving satisfactory results, but also reduces average hospital stay and complication rates.
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Affiliation(s)
- Yao‐bin Wang
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
| | - Xiao‐bing Zhao
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Bin Geng
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Xiao‐yun Sheng
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Kai Zhang
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
| | - Chen Cao
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
| | - Ya‐yi Xia
- Department of OrthopaedicsLanzhou University Second HospitalLanzhouChina
- Gansu Provincial Orthopaedic Clinical Medicine Research CenterLanzhouChina
- Key Laboratory of Bone and Joint Disease Research of Gansu ProvinceLanzhouChina
| | - Shu‐lian Chen
- Department of Spinal and Spinal Cord surgeryHenan Provincial People's HospitalZhengzhouChina
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Wilent WB, Tesdahl EA, Trott JT, Tassone S, Harrop JS, Klineberg EO, Sestokas AK. Impact of inhalational anesthetic agents on the baseline monitorability of motor evoked potentials during spine surgery: a review of 22,755 cervical and lumbar procedures. Spine J 2021; 21:1839-1846. [PMID: 34274500 DOI: 10.1016/j.spinee.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/01/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT During spine surgery, motor evoked potentials (MEPs) are often utilized to monitor both spinal cord function and spinal nerve root or plexus function. While there are reports evaluating the impact of anesthesia on the ability of MEPs to monitor spinal cord function, less is known about the impact of anesthesia on the ability of MEPs to monitor spinal nerve root and plexus function. PURPOSE To compare the baseline monitorability and amplitude of MEPs during cervical and lumbar procedures between two cohorts based on the maintenance anesthetic regimen: a total intravenous anesthesia (TIVA) versus a regimen balanced with volatile inhalational and intravenous agents. STUDY DESIGN Baseline MEP data from a total of 16,559 cervical and 6,196 lumbar extradural spine procedures utilizing multimodality intraoperative neuromonitoring (IONM) including MEPs between January 2017 and March 2020 were obtained from a multi-institutional database. Two cohorts for each region of spine surgery were delineated based on the anesthetic regimen: a TIVA cohort and a Balanced anesthesia cohort. PATIENT SAMPLE Age 18 and older. Fellowship support for 65,000 for year 2021. OUTCOME MEASURES Percent monitorability and amplitudes of baseline MEPs. METHODS The baseline monitorability of each muscle MEP was evaluated by the IONM team in real-time and recorded in the patient's electronic medical record. The relation between anesthetic regimen and baseline monitorability was estimated using mixed effects logistic regression, with distinct models for cervical and lumbar procedures. Subsets of cervical and lumbar procedures from each anesthesia cohort in which all MEPs were deemed monitorable were randomly selected and the average peak-to-trough amplitude of each muscle MEP was retrospectively measured. Mixed-effects linear regression models were estimated (one each for cervical and lumbar procedures) to assess possible differences in average amplitude associated with anesthesia regimen. RESULTS At the time of surgery, baseline MEPs were reported monitorable from all targeted muscles in 86.8% and 83.0% of cervical and lumbar procedures, respectively, for the TIVA cohort, but were reported monitorable in just 59.3% and 61.0% of cervical and lumbar procedures, respectively, in the Balanced cohort, yielding disparities of 27.5% and 22.0%, respectively. The model-adjusted monitorability disparity between cohorts for a given muscle MEP ranged from 0.2% to 16.6% but was smallest for distal intrinsic hand and foot muscle MEPs (0.2%-1.1%) and was largest for proximal muscle MEPs (deltoid: 10.8%, biceps brachii: 8.8%, triceps: 13.0%, quadriceps: 16.6%, gastrocnemius: 7.8%, and tibialis anterior: 3.7%) where the monitorability was significantly decreased in the Balanced cohort relative to the TIVA cohort (p<.0001). Relative to the TIVA cohort, the model-adjusted amplitude of an MEP in the Balanced cohort was smaller for all muscles measured, ranging from 27.5% to 78.0% smaller. Relative to the TIVA cohort, the model-adjusted amplitude of an MEP was significantly decreased (p<.01) in the Balanced cohort for the most proximal muscles (Percent smaller: deltoid: 74.3%, biceps: 78.0%, triceps: 54.9%, quadriceps: 54.8%). CONCLUSIONS TIVA is the preferred anesthetic regimen for optimizing MEP monitoring during spine surgery. Inhalational agents significantly decrease MEP monitorability and amplitudes for most muscles, and this effect is especially pronounced for proximal limb muscles such as the deltoid, biceps, triceps, and quadriceps.
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Affiliation(s)
- W Bryan Wilent
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027.
| | - Eric A Tesdahl
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - Julie T Trott
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - Shakira Tassone
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - James S Harrop
- Jefferson University Hospital, 909 Walnut Street Clinical Office Building: 2nd Floor, Philadelphia, PA 19107
| | - Eric O Klineberg
- University of California Davis, 3301 C St., Suite 1500, Sacramento, CA 95816
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Xiang B, Jiao S, Zhang Y, Wang L, Yao Y, Yuan F, Chen R, Zhou Q. Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked potential monitoring during neurosurgery: a randomized controlled trial. BMC Anesthesiol 2021; 21:240. [PMID: 34620093 PMCID: PMC8496030 DOI: 10.1186/s12871-021-01463-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/30/2021] [Indexed: 01/27/2023] Open
Abstract
Background Better protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring. Methods A total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded. Results SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly. Conclusions SEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients studied had normal neurological examination findings, hence, these results may not be applicable to patients with preexisting deficits. Trial registration The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR2100045504 (18/04/2021).
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Affiliation(s)
- Bingbing Xiang
- Department of Anesthesiology, Chengdu Fifth People's Hospital, Chengdu, 611130, China
| | - Shulan Jiao
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China.
| | - Yulong Zhang
- Department of Anesthesiology, Kunming Children's Hospital, Kunming, 650101, China
| | - Lu Wang
- Department of Anesthesiology, First People's Hospital of Yunnan Province, Kunming, 650101, China
| | - Yuting Yao
- Department of Anesthesiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Feng Yuan
- Department of Anesthesiology, Chengdu Fifth People's Hospital, Chengdu, 611130, China
| | - Rui Chen
- Department of Anesthesiology, Chengdu Fifth People's Hospital, Chengdu, 611130, China
| | - Qijun Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China
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Wilent WB, Trott JM, Sestokas AK. Roadmap for Motor Evoked Potential (MEP) Monitoring for Patients Undergoing Lumbar and Lumbosacral Spinal Fusion Procedures. Neurodiagn J 2021; 61:27-36. [PMID: 33945448 DOI: 10.1080/21646821.2021.1866934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
MEPs are recommended for patients undergoing lumbar and lumbosacral procedures in which intraoperative neuromonitoring (IONM) is being utilized. While electromyography (EMG) provides critical nerve root proximity information, spontaneous EMG discharges are relatively poor at reliably diagnosing spinal nerve root dysfunction. In contrast, research indicates that MEPs are both sensitive and specific in diagnosing evolving spinal nerve root dysfunction. There is conflicting evidence, however, and it must be emphasized that the value of adding MEPs is only realized when practices and techniques are optimized. The ideal anesthetic plan is an optimized total intravenous anesthetic (TIVA) regimen. Selection of appropriate anesthetics and dosing is important for optimizing baseline response amplitudes and promoting diagnostic confidence in analyzing signal changes. An adaptive set of alert criteria that account for baseline amplitude and morphology fluctuations should guide the determination of significant signal change. The therapeutic impact of accurate diagnostic information depends on the timeliness of diagnosis and intervention. Prior to the start of surgery, a plan to obtain MEPs at least once every 10 minutes during the active part of the procedure and after every significant surgical maneuver should be agreed upon, and the intervention plan should include but not be limited to possible removal of hardware and release of retraction or distractive forces. In summary, MEPs can improve monitoring of at-risk nerve root function, but the accuracy and therapeutic impact of such monitoring depend on perioperative planning and communication that optimize use of this modality.
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Affiliation(s)
| | - Julie M Trott
- Medical Department, SpecialtyCare, Brentwood, Tennessee
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