Acute recurrent bradycardia with evoked potential loss during transforaminal lumbar interbody fusion

C, Schwan; Pedersen, Mette; Tavanaiepour, Kourosh; Tavanaiepour, Daryoush; Hoefnagel, A. L.; Mongan, Paul D.

doi:10.1002/anr3.12049

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…The number of spinal surgeries each year is increasing rapidly, and surgeons are constantly looking for new ways to reduce costs and potential surgical complications, particularly iatrogenic spinal injuries [ 9 ]. Spinal cord iatrogenic injuries that occur during instrument manipulation are a major concern for the spine and spinal surgeons, and the need for intraoperative monitoring to assess spinal cord functional integrity becomes even more important as innovative devices are increasingly used in spinal surgery [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Application of Intraoperative Electromyography Intelligent Monitoring in Orthopedic Surgery under General Anesthesia

Zhang

Duan

Chen

et al. 2023

Contrast Media & Molecular Imaging

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To study the application of intraoperative EMG intelligent monitoring in orthopedic surgery under general anesthesia, a total of 53 patients who underwent orthopedic surgery from February 2021 to February 2022 were selected. The combined monitoring of somatosensory evoked potential (SEP), motor evoked potential (MEP), and electromyography (EMG) was used to analyze the monitoring efficiency. In 38 of the 53 patients, the intraoperative signal was normal, and there was no postoperative neurological dysfunction; one case had abnormal signal, and the abnormality still existed after debugging, but no obvious neurological dysfunction was found after operation; the remaining 14 cases had abnormal signal. There were 13 early warnings in SEP monitoring; 12 early warnings in MEP monitoring; 10 early warnings in EMG monitoring. There were 15 cases of early warning in the joint monitoring of the three, and the sensitivity of the combined monitoring of SEP + MEP + EMG was significantly higher than that of the single monitoring of SEP, MEP, and EMG p < 0.05 . There was no significant difference in specificity, positive predictive value, and negative predictive value between combined monitoring and single monitoring p > 0.05 . The combined monitoring of EMG, MEP, and SEP in orthopedic surgery can significantly improve the safety of surgery, its sensitivity and negative predictive value were significantly higher than the monitoring effects of the two alone.

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Section: Discussionmentioning

confidence: 99%

Application of Intraoperative Electromyography Intelligent Monitoring in Orthopedic Surgery under General Anesthesia

Zhang

Duan

Chen

et al. 2023

Contrast Media & Molecular Imaging

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“…Furthermore, previous studies revealed that hypotension intraoperatively can increase the likelihood of neurologic deficits by reducing spinal cord perfusion pressure (Joshua Yang et al, 2018;CoreyWalker and Park, 2020). Schwan et al (2020) reported that evoked potential waveforms can be lost after recurrent bradycardia during spinal surgery. So, bradycardia and hypotension should be avoided strictly during spinal surgeries, according to the latest guidance (Vitale et al, 2014;CoreyWalker and Park, 2020).…”

Section: Effects Of Dexmedetomidine On Cardiovascular Stabilitymentioning

confidence: 99%

A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study

Liu

Qin

et al. 2022

Front. Pharmacol.

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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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Unexpected Bradycardia Related to Surgical Manipulation During Thoracolumbar Spinal Surgery

et al. 2023

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Acute recurrent bradycardia with evoked potential loss during transforaminal lumbar interbody fusion

Cited by 3 publications

References 10 publications

Application of Intraoperative Electromyography Intelligent Monitoring in Orthopedic Surgery under General Anesthesia

Application of Intraoperative Electromyography Intelligent Monitoring in Orthopedic Surgery under General Anesthesia

A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study

Unexpected Bradycardia Related to Surgical Manipulation During Thoracolumbar Spinal Surgery

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