Effect of Low-Dose Ketamine on Voltage Requirement for Transcranial Electrical Motor Evoked Potentials in Children

Zaarour, Christian; Engelhardt, Thomas; Strantzas, Samuel; Pehora, Carolyne; Lewis, Stephen F.; Crawford, Mark W.

doi:10.1097/brs.0b013e3181573eb4

Cited by 25 publications

(16 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anesthesiologists believe that ketamine does not affect MEP amplitude. Indeed, bolus administration of ketamine 0.5 mg/kg during either propofol/remifentanil or N 2 O/sufentanil anesthesia has been reported to have no significant influence on the amplitude of MEPs evoked by transcranial electrical stimulation [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report

et al. 2018

View full text Add to dashboard Cite

BackgroundIt is believed that ketamine does not affect motor-evoked potential amplitude, whereas various anesthetic drugs attenuate the amplitude of transcranial motor-evoked potential. However, we encountered a patient with marked attenuation of motor-evoked potential amplitude after intravenous bolus administration of ketamine.Case presentationA 15-year-old Japanese girl with a diagnosis of adolescent idiopathic scoliosis was admitted to our hospital to undergo posterior spinal fusion at T4–L3. After induction of general anesthesia using a continuous infusion of propofol and remifentanil, we confirmed that transcranial electrical motor-evoked potentials were being recorded correctly. Ketamine 1.25 mg/kg was administered intravenously for intraoperative and postoperative analgesia. About 3 minutes later, the motor-evoked potential amplitude was markedly attenuated. No other drugs were administered except for ketamine. The patient’s vital signs were stable, and the surgery had not yet started. The motor-evoked potential amplitude was recovered at about 6 minutes after administration of ketamine. The surgery was performed uneventfully, and the patient had no neurologic deficit when she emerged from general anesthesia.ConclusionsAlthough there is a widely held belief in the field of anesthesiology that ketamine does not affect motor-evoked potential amplitude, it has been suggested that ketamine could affect its monitoring.

show abstract

Section: Discussionmentioning

confidence: 99%

Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Ketamine is known to enhance the monitoring of evoked potentials, 7 and has demonstrated its utility in a number of studies. 24,29,32 Dexmedetomidine has been used as a supplement to TIVA to reduce the dose of propofol, without evidence of detriment.…”

Section: Resultsmentioning

confidence: 99%

Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature

Wang¹,

Than²,

Etame³

et al. 2009

FOC

View full text Add to dashboard Cite

Object Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential. Methods A literature search of the National Library of Medicine database was conducted to identify articles pertaining to anesthesia and TcMEP monitoring during spine surgery. Twenty studies were selected and reviewed. Results Inhalational anesthetics and neuromuscular blockade have been shown to limit the ability of TcMEP monitoring to detect significant changes. Hypothermia can also negatively affect monitoring. Opioids, however, have little influence on TcMEPs. Total intravenous anesthesia regimens can minimize the need for inhalational anesthetics. Conclusions In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.

show abstract

“…antagonistic property [8]. In a study by Inoue et al [16], patients received either 1 mg/kg/hr of ketamine or 4 mg/ kg/hr of propofol as maintenance anesthetic agents along with 50% N 2 O in oxygen and 4-5 µg/kg/hr fentanyl.…”

Section: Discussionmentioning

confidence: 99%

“…Ketamine [ 8 ], dexmedetomidine [ 9 ], and lidocaine [ 10 ] have been used as adjuvants to reduce propofol requirements with variable effects on TcMEPs. The ketamine–propofol admixture (ketofol) has been used successfully in various procedures and produces rapid onset of sedation, appropriate hemodynamic conditions, and rapid recovery [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery

et al. 2022

View full text Add to dashboard Cite

The primary purpose was to compare the effects of propofol and ketofol on amplitudes and latencies of transcranial motor evoked potentials (TcMEPs) during thoracolumbar spine surgery. In addition, intraoperative hemodynamics and muscle power were compared. Overview of Literature: Propofol is commonly used during intraoperative TcMEP monitoring. However, propofol inhibits TcMEP amplitudes and causes hypotension in a dose-dependent fashion. Methods: Amplitude and latency of TcMEPs were recorded bilaterally from the abductor pollicis brevis (APB) and abductor hallucis (AH) muscles in 38 adult American Society of Anesthesiologists I and II patients undergoing thoracolumbar spine surgery. Baseline recordings of TcMEPs in both groups were recorded under propofol infusion. Group X patients then received propofol and fentanyl (1 mcg/ kg/hr), and group Y patients received ketofol and fentanyl (1 mcg/kg/hr). Bispectral index was maintained at 40-60 in both groups. Amplitude and latency were recorded at 30 minutes intervals for 2 hours. Results: Propofol caused no significant changes in amplitude and latency in any muscle. In contrast, amplitude increased significantly at all time points in the bilateral APB muscles and 60, 90, and 120 minutes in the left AH muscle without changes in latency in response to ketofol. When the two groups were compared, ketofol induced significantly higher amplitudes at 60, 90, and 120 minutes in the (left) APB, at all time points in the (right) APB, and at 120 minutes in both AH muscles, compared with propofol. Blood pressures were lower and fluid and vasopressor requirements were higher in group X. Muscle power was similar between the two groups. Conclusions: Ketofol facilitates TcMEP amplitudes without affecting latency. Use of ketofol resulted in a better and more stable hemodynamic profile than did use of propofol.

show abstract

Effect of Low-Dose Ketamine on Voltage Requirement for Transcranial Electrical Motor Evoked Potentials in Children

Abstract: Addition of low-dose ketamine to propofol/remifentanil anesthesia does not significantly reduce the voltage needed to elicit maximum amplitude of the motor-evoked response to transcranial electrical stimulation.

Cited by 25 publications

References 28 publications

Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report

Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report

Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature

Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery

Contact Info

Product

Resources

About