Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2020; 07(02): 084-090
DOI: 10.1055/s-0039-3400549
Original Article

Effect of Two Anesthetic Regimes with Dexmedetomidine as Adjuvant on Transcranial Electrical Motor Evoked Potentials during Spine Surgery

Rajeeb K. Mishra
1   Department of Neuroanaesthesiology and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
Hemanshu Prabhakar
2   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Indu Kapoor
2   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Dinu S. Chandran
3   Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
,
Arvind Chaturvedi
2   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Transcranial motor evoked potential (TcMEP) recording during spinal cord/spinal column surgery is a reliable and valid diagnostic adjunct to assess spinal cord integrity and is recommended if utilized for this purpose. Electrophysiologic monitoring in terms of TcMEP has been proven to be a useful tool in detecting spinal cord dysfunction at the earliest and allows corrective action to be taken before permanent neuronal dysfunction sets in. The quality of intraoperative neuromonitoring is influenced by various factors. Most anesthetics used in clinical practice suppress the evoked potentials. Thus, selecting an appropriate technique is always a challenging task.

Materials and Methods Thirty ASA I and II patients scheduled for elective dorsolumbar spine surgery with TcMEP monitoring were recruited in the study. Patients were randomized into three groups: (1) Propofol (group P) 100 to 150 µg/kg/min with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, (2) desflurane (group D) (<0.5 MAC) with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, and (3)standard group (group S) patients received propofol 100 to 150 µg/kg/min, fentanyl 1 µg/kg/hr along with equal volume of saline (placebo). TcMEP amplitudes were recorded bilaterally from electrodes placed at least in one set of muscles with motor origin rostral and one set of muscle caudal to the spinal level of lesion at different time points.

Results Three patients were excluded after allocation; 27 out of 30 patients were analyzed. The demographic and surgical characteristics of patients were comparable. The stimulation voltage needed to elicit the responses in all the three groups was comparable. No difference was observed in brachioradialis muscle amplitudes between the groups at different time points. However, in the right brachioradialis muscle, we found reduced amplitudes at baseline in group D and at 120 minutes in group P. We noticed reduced amplitudes of bilateral brachioradialis muscle in group P at 60 minutes and 90 minutes with respect to the baseline. For lower extremity, we measured amplitudes of TcMEP in tibialis anterior (TA) and did not find any difference in amplitudes between the groups at different time points.

Conclusion We observed that the desflurane–dexmedetomidine combination did not hinder TcMEP as compared with both standard and propofol–dexmedetomidine groups. Thus, this combined regime could be used in surgeries requiring motor evoked potential monitoring.

Keywords

dexmedetomidine - propofol - desflurane - transcranial electrical motor evoked potential - amplitude - spine surgery


Publication History

Article published online:
20 January 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Hadley MN, Shank CD, Rozzelle CJ, Walters BC. Guidelines for the use of electrophysiological monitoring for surgery of the human spinal column and spinal cord. Neurosurgery 2017; 81 (05) 713-732
    CrossrefPubMedGoogle Scholar
  • 2 Sloan TB. Evoked potential monitoring. Int Anesthesiol Clin 1996; 34 (03) 109-136
    PubMedGoogle Scholar
  • 3 Sloan TB, Janik D, Jameson L. Multimodality monitoring of the central nervous system using motor-evoked potentials. Curr Opin Anaesthesiol 2008; 21 (05) 560-564
    CrossrefPubMedGoogle Scholar
  • 4 Chen X, Sterio D, Ming X. et al. Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 2007; 24 (03) 281-285
    CrossrefPubMedGoogle Scholar
  • 5 Deletis V, Kiprovski K, Morota N. The influence of halothane, enflurane, and isoflurane on motor evoked potentials. Neurosurgery 1993; 33 (01) 173-174
    PubMedGoogle Scholar
  • 6 Pelosi L, Stevenson M, Hobbs GJ, Jardine A, Webb JK. Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol 2001; 112 (06) 1076-1087
    CrossrefPubMedGoogle Scholar
  • 7 Lotto ML, Banoub M, Schubert A. Effects of anesthetic agents and physiologic changes on intraoperative motor evoked potentials. J Neurosurg Anesthesiol 2004; 16 (01) 32-42
    CrossrefPubMedGoogle Scholar
  • 8 Clapcich AJ, Emerson RG, Roye Jr DP. et al. The effects of propofol, small-dose isoflurane, and nitrous oxide on cortical somatosensory evoked potential and bispectral index monitoring in adolescents undergoing spinal fusion. Anesth Analg 2004; 99 (05) 1334-1340
    PubMedGoogle Scholar
  • 9 Sloan TB, Toleikis JR, Toleikis SC, Koht A. Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3% desflurane. J Clin Monit Comput 2015; 29 (01) 77-85
    CrossrefPubMedGoogle Scholar
  • 10 Hernández-Palazón J, Izura V, Fuentes-García D, Piqueras-Pérez C, Doménech-Asensi P, Falcón-Araña L. Comparison of the effects of propofol and sevoflurane combined with remifentanil on transcranial electric motor-evoked and somatosensory-evoked potential monitoring during brainstem surgery. J Neurosurg Anesthesiol 2015; 27 (04) 282-288
    CrossrefPubMedGoogle Scholar
  • 11 Chong CT, Manninen P, Sivanaser V, Subramanyam R, Lu N, Venkatraghavan L. Direct comparison of the effect of desflurane and sevoflurane on intraoperative motor-evoked potentials monitoring. J Neurosurg Anesthesiol 2014; 26 (04) 306-312
    CrossrefPubMedGoogle Scholar
  • 12 Malcharek MJ, Loeffler S, Schiefer D. et al. Transcranial motor evoked potentials during anesthesia with desflurane versus propofol—a prospective randomized trial. Clin Neurophysiol 2015; 126 (09) 1825-1832
    CrossrefPubMedGoogle Scholar
  • 13 Sloan TB, Mongan P, Lyda C, Koht A. Lidocaine infusion adjunct to total intravenous anesthesia reduces the total dose of propofol during intraoperative neurophysiological monitoring. J Clin Monit Comput 2014; 28 (02) 139-147
    CrossrefPubMedGoogle Scholar
  • 14 Bala E, Sessler DI, Nair DR, McLain R, Dalton JE, Farag E. Motor and somatosensory evoked potentials are well maintained in patients given dexmedetomidine during spine surgery. Anesthesiology 2008; 109 (03) 417-425
    CrossrefPubMedGoogle Scholar
  • 15 Rozet I, Metzner J, Brown M. et al. Dexmedetomidine does not affect evoked potentials during spine surgery. Anesth Analg 2015; 121 (02) 492-501
    CrossrefPubMedGoogle Scholar
  • 16 Sloan T. Anesthesia and intraoperative neurophysiological monitoring in children. Childs Nerv Syst 2010; 26 (02) 227-235
    CrossrefPubMedGoogle Scholar
  • 17 Mahmoud M, Sadhasivam S, Salisbury S. et al. Susceptibility of transcranial electric motor-evoked potentials to varying targeted blood levels of dexmedetomidine during spine surgery. Anesthesiology 2010; 112 (06) 1364-1373
    CrossrefPubMedGoogle Scholar
  • 18 Liu Q, Wang Q, Liu H, Wu WKK, Chan MTV. Warning criteria for intraoperative neurophysiologic monitoring. Curr Opin Anaesthesiol 2017; 30 (05) 557-562
    CrossrefPubMedGoogle Scholar
  • 19 Holdefer RN, Anderson C, Furman M, Sangare Y, Slimp JC. A comparison of the effects of desflurane versus propofol on transcranial motor-evoked potentials in pediatric patients. Childs Nerv Syst 2014; 30 (12) 2103-2108
    CrossrefPubMedGoogle Scholar
  • 20 Shida Y, Shida C, Hiratsuka N, Kaji K, Ogata J. High-frequency stimulation restored motor-evoked potentials to the baseline level in the upper extremities but not in the lower extremities under sevoflurane anesthesia in spine surgery. J Neurosurg Anesthesiol 2012; 24 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 21 Lyon R, Feiner J, Lieberman JA. Progressive suppression of motor evoked potentials during general anesthesia: the phenomenon of “anesthetic fade.”. J Neurosurg Anesthesiol 2005; 17 (01) 13-19
    PubMedGoogle Scholar