Improvement of Motor-Evoked Potentials by Ketamine and Spatial Facilitation During Spinal Surgery in a Young Child

Erb, Thomas O.; Ryhult, Sven E; Duitmann, Ewald; Hasler, Carol; Luetschg, Juerg; Frei, Franz J.

doi:10.1213/01.ane.0000149896.52608.08

Cited by 33 publications

(13 citation statements)

References 17 publications

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“…Our data confirm that reliable signals predicting postoperative neurological function may be established in a majority of these patients with a standard anesthetic regimen and stimulation protocol, even in children with a preexisting neurological or muscular disease. 9 …”

Section: Discussionmentioning

confidence: 99%

Intraoperative monitoring of motor evoked potentials in very young children

Fulkerson

Satyan

Wilder

et al. 2011

PED

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Object Neurophysiological monitoring of motor evoked potentials (MEPs) during complex spine procedures may reduce the risk of injury by providing feedback to the operating surgeon. While this tool is a well-established surgical adjunct in adults, clinical data in children are sparse. The purpose of this study was to determine the reliability and safety of MEP monitoring in a group of children younger than 3 years of age undergoing neurosurgical spine procedures. Methods A total of 10 consecutive spinal procedures in 10 children younger than 3 years of age (range 5–31 months, mean 16.8 months) were analyzed between January 1, 2008, and May 1, 2010. Motor evoked potentials were elicited by transcranial electric stimulation. A standardized anesthesia protocol for monitoring consisted of a titrated propofol drip combined with bolus dosing of fentanyl or sufentanil. Results Motor evoked potentials were documented at the beginning and end of the procedure in all 10 patients. A mean baseline stimulation threshold of 533 ± 124 V (range 321–746 V) was used. Six patients maintained MEP signals ≥ 50% of baseline amplitude throughout the surgery. There was a greater than 50% decrease in intraoperative MEP amplitude in at least 1 extremity in 4 patients. Two of these patients returned to baseline status by the end of the case. Two patients had a persistent decrement or variability in MEP signals at the end of the procedure; this correlated with postoperative weakness. There were no complications related to the technique of monitoring MEPs. Conclusions A transcranial electric stimulation protocol monitoring corticospinal motor pathways during neurosurgical procedures in children younger than 3 years of age was reliably and safely implemented. A persistent intraoperative decrease of greater than 50% in this small series of 10 pediatric patients younger than 3 years of age predicted a postoperative neurological deficit. The authors advocate routine monitoring of MEPs in this pediatric age group undergoing neurosurgical spine procedures.

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Section: Discussionmentioning

confidence: 99%

Intraoperative monitoring of motor evoked potentials in very young children

Fulkerson

Satyan

Wilder

et al. 2011

PED

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“…10,23,24 However, the magnitude of MEP amplitude decreases can be substantial and loss or absence of MEPs did occur even when propofol was administered in small doses (50 -100 g/kg per minute) in a child Ͻ6 years of age. 25 Nitrous oxide (N 2 O) was added to our anesthetic regimen because it increases the depth of anesthesia and thereby decreases the likelihood of awareness of the patient during anesthesia with low-dose propofol. Also, the effect of N 2 O can be eliminated in a few minutes because of its low solubility coefficient.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring of Motor-Evoked Potentials in Children Undergoing Spinal Surgery

Frei¹,

Ryhult²,

Duitmann³

et al. 2007

Spine

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“…More recently, interest has been shown in using ketamine and dexmedetomidine as part of a TIVA regimen. 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

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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.

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Improvement of Motor-Evoked Potentials by Ketamine and Spatial Facilitation During Spinal Surgery in a Young Child

Cited by 33 publications

References 17 publications

Intraoperative monitoring of motor evoked potentials in very young children

Intraoperative monitoring of motor evoked potentials in very young children

Intraoperative Monitoring of Motor-Evoked Potentials in Children Undergoing Spinal Surgery

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

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