Anesthesia management of neonates and infants requiring intraoperative neurophysiological monitoring: A concise review

Nakahari, Hirofumi; Wilton, Niall; Kojima, Taiki

doi:10.1111/pan.14670

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…Processed electroencephalogram (PEEG) monitoring can support maintenence of the optimal anaesthetic plane and avoid excessive dose of anaesthetics in adults. However, the bispectral index in neonates and infants can be misinterpreted due to the difference in EEG waveforms between young children and adults [9]. The knowledge of pharmacokinetics and pharmacodynamics of propofol in neonates and infants can facilitate adjustment of propofol to achieve adequate amnesia without suppression of MEPs including anaesthetic fade and minimising the risk of propofol infusion syndrome.…”

Section: Discussionmentioning

confidence: 99%

Low‐dose sevoflurane co‐administered with propofol‐based general anaesthesia obliterates intra‐operative neurophysiological monitoring in an infant

Nakahari,

Wilton,

Ikeda

et al. 2023

Anaesthesia Reports

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SummaryThe influence of general anaesthetic agents on intra‐operative neurophysiological monitoring in neonates and infants has rarely been reported. Propofol‐based anaesthesia is recommended to avoid suppression of neurophysiological monitoring. However, the administration of propofol in children undergoing prolonged procedures, especially those younger than six months, should be carefully controlled due to the potential risk of propofol infusion syndrome. Adding a small dose of inhalational anaesthetic can be an option to reduce propofol requirements. Recent guidelines in Japan suggest limiting inhalational anaesthetics to less than 0.5 minimum alveolar concentrations when co‐administered with low‐dose propofol during intra‐operative neuromonitoring. However, there is still insufficient evidence regarding the impact of sevoflurane on neurophysiological monitoring when co‐administered with propofol in infants. This report describes a case of a three‐month‐old infant undergoing spinal lipoma resection in which there was a dramatic suppression of neurophysiological monitoring with the addition of 0.35–0.45% sevoflurane to propofol‐based anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Low‐dose sevoflurane co‐administered with propofol‐based general anaesthesia obliterates intra‐operative neurophysiological monitoring in an infant

Nakahari,

Wilton,

Ikeda

et al. 2023

Anaesthesia Reports

Self Cite

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“…This cooperative multi-objective monitoring structure can monitor and identify the disconnector motor in full coverage, adjust, integrate, classify and summarize the data and information through the data center, process and analyze the monitoring data and extract useful information. Data is transmitted to other systems or devices as needed [24]. It provides reference for the subsequent determination and analysis [25].…”

Section: Deploy Multi-objective Status Monitoring Nodesmentioning

confidence: 99%

Condition monitoring of disconnecting switch opening and closing motor based on electromagnetic transient

You,

Liu,

Liu

et al. 2024

Fourth International Conference on Mechanical, Electronics, and Electrical and Automation Control (METMS 2024)

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Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study

Kojima,

Nakahari,

Ikeda

et al. 2024

J Anesth

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Purpose The influence of anesthetic interactions on motor-evoked potentials in infants has rarely been reported. In infants, adding a small dose of sevoflurane to propofol-based total intravenous anesthesia is reasonable for reducing propofol administration. We collected preliminary data regarding the effect of low-dose sevoflurane in propofol-based total intravenous anesthesia on motor-evoked potentials in infants. Methods This pilot interventional study included 10 consecutive infants requiring motor-evoked potentials between January 2023 and March 2024. The motor-evoked potential amplitudes in the upper and lower extremities were recorded twice when general anesthesia was maintained using (1) propofol-based total intravenous anesthesia and (2) 0.1–0.15 age-adjusted minimum alveolar concentration sevoflurane + propofol-based total intravenous anesthesia. Results The motor-evoked potential amplitude in the right upper extremity was not significantly different after the addition of a small dose of sevoflurane [192 (75.3–398) μV, 121 (57.7–304) μV, P = 0.19]. All the motor-evoked potential amplitudes in the right lower extremity (quadriceps femoris, anterior tibialis, and gastrocnemius muscles) were significantly attenuated by adding a small dose of sevoflurane (median [interquartile range]: 47.9 [35.4–200] μV, 25.2 [12.4–55.3] μV, P = 0.014; 74.2 [51.9–232] μV, 31.2 [2.7–64] μV, P = 0.0039; 29.8 [20–194] μV, 9.9 [3.8–92.4] μV, P = 0.0039, respectively). Similar results were observed in the left lower extremities. Conclusion Adding even 0.1–0.15 age-adjusted minimum alveolar concentration sevoflurane to propofol-based total intravenous anesthesia attenuated the motor-evoked potential amplitudes in the lower extremities. A further prospective interventional study with an appropriate sample size is required to investigate the study hypothesis.

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Anesthesia management of neonates and infants requiring intraoperative neurophysiological monitoring: A concise review

Abstract: Intraoperative neurophysiological monitoring is currently used to prevent intraoperative spinal cord and nerve injuries during neonatal and infant surgeries. However,

Cited by 4 publications

References 36 publications

Low‐dose sevoflurane co‐administered with propofol‐based general anaesthesia obliterates intra‐operative neurophysiological monitoring in an infant

Low‐dose sevoflurane co‐administered with propofol‐based general anaesthesia obliterates intra‐operative neurophysiological monitoring in an infant

Condition monitoring of disconnecting switch opening and closing motor based on electromagnetic transient

Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study

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