Intraoperative Myogenic Motor Evoked Potentials Induced by Direct Electrical Stimulation of the Exposed Motor Cortex Under Isoflurane and Sevoflurane

Kawaguchi, Masahiko; Sakamoto, T.; Ohnishi, Hideyuki; Shimizu, Kiyoshí; Karasawa, Jun; Furuya, Hitoshi

doi:10.1213/00000539-199603000-00029

Cited by 9 publications

(11 citation statements)

References 17 publications

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“…Although neurogenic potentials from the spinal cord or peripheral neural structures are far less affected by anesthesia, 32,34 recording these potentials requires invasive placement of electrodes and is therefore not routinely used in clinical practice. For this reason, a wealth of stimulation methods, including different facilitation paradigms as well as repetitive stimulation, 2,11,13,14,20,22,23,25,29 has been applied to MEP monitoring to increase the reliability of myogenic MEPs. The influence of anesthesia on MEPs, however, mainly in the registration of myogenic potentials, has prevented the widespread use of MEPs in routine intraoperative electrophysiological monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…In earlier investigations it has been shown that volatile anesthetic agents induce marked suppression of both neurogenic and myogenic potentials at alveolar concentrations common-ly used in neuroanesthesia. 8,13,14,23,30,32,34 Therefore, numerous studies have been undertaken to quantify the effects of various intravenous anesthetic agents on MEPs. 10,12,17,26-30, 33,34 Nevertheless, a systematic approach that addresses the choice of the most appropriate anesthetic protocol, depending on individual requirements for both anesthesia and electrophysiological monitoring, has been lacking.…”

mentioning

confidence: 99%

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Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data

Scheufler¹,

Zentner²

2002

Journal of Neurosurgery

158

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data

Scheufler¹,

Zentner²

2002

Journal of Neurosurgery

158

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“…This study confirms previous results that the use of paired transcranial stimulation partly overcomes the anaesthetic-induced depression of the myogenic response during nitrous oxide-opioid 10 and isoflurane anaesthesia. 11 The observed amplitude augmentation with paired stimuli is most likely the result of temporal summation; the first stimulus lowers the excitation threshold of the cortical and spinal motor neurones, thereby facilitating initiation of neuronal discharge by the second stimulus. 10 It is conceivable that stimulation with more than two successive pulses might further increase intraoperative tc-MER amplitudes and result in a greater success rate of tc-MER monitoring during propofol-opioid anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Kawaguchi and coworkers described the effects of single pulse and train-of-five electrical stimulation of the exposed motor cortex on the tibialis anterior myogenic response during an anaesthetic regimen consisting of nitrous oxide and isoflurane or sevoflurane. 11 With train-of-five stimulation they were able to record tc-MER in all patients with concentrations of the volatile anaesthetic up to 1.5 times the minimum alveolar concentration.…”

Section: Discussionmentioning

confidence: 99%

“…The purpose of this crossover study was to determine the relative effects of nitrous oxide and propofol on tc-MER amplitude, amplitude variability and onset latencies. As it was shown recently that multiple stimuli may improve the efficiency of transcranial stimulation, [8][9][10][11] comparison of the two anaesthetic regimens was performed with both single and paired stimuli.…”

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confidence: 99%

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Differential effects of nitrous oxide and propofol on myogenic transcranial motor evoked responses during sufentanil anaesthesia

Ubags¹,

Kalkman²,

Been³

et al. 1997

British Journal of Anaesthesia

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We have compared the effects of 50% nitrous oxide and propofol, each administered concurrently with sufentanil, on the amplitudes and latencies of the compound muscle action potential (CMAP) response to transcranial electrical stimulation. Using a crossover design, 12 patients undergoing spinal surgery were exposed to both 50% nitrous oxide and propofol, the latter in a bolus-infusion regimen. Six patients received nitrous oxide first and six received propofol first. CMAP were recorded from the tibialis anterior muscle in response to both single and paired transcranial electrical stimuli. With single pulse stimulation, median CMAP amplitude was significantly greater during administration of nitrous oxide than propofol (nitrous oxide 335 (10th-90th percentiles 35-849) microV; propofol 36 (0-251) microV) (P < 0.01). With paired stimulation, there was no significant difference in CMAP amplitude during the two regimens (nitrous oxide 1031 (296-1939) microV; propofol 655 (0-1867) microV). The results indicate that propofol caused more depression of transcranial electrical motor evoked responses than 50% nitrous oxide but that the difference was probably clinically unimportant when a paired stimulation paradigm was used.

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Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists, Part 2: The Anesthetic Considerations

Masohood,

Paquin-Lanthier,

Chui

et al. 2023

J Neuroanaesth Crit Care

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Intraoperative language and sensorimotor function mapping with direct electrical stimulation allows precise identification of functionally important brain regions. Direct electrical stimulation brain mapping has become the standard of care for the resection of brain lesions near or within eloquent regions with various patient outcome benefits. Intraoperative stimulation mapping (ISM) is commonly performed in an awake patient for language and motor assessments. However, motor mapping under general anesthesia, termed asleep motor mapping, has been increasingly performed over the last two decades for lesions primarily affecting the motor areas of the brain. Both asleep-awake-asleep and monitored anesthesia care have been successfully used for awake craniotomy in modern neuroanesthesia. Each anesthetic agent exerts varying effects on the quality of ISM, especially under general anesthesia. Careful selection of an anesthetic technique is crucial for the successful performance of ISM in both awake and asleep conditions. A comprehensive search was performed on electronic databases such as PubMed, Embase, Cochrane, Scopus, Web of Science, and Google Scholar to identify articles describing anesthesia for awake craniotomy, intraoperative brain mapping, and asleep motor mapping. In the second part of this narrative review, we summarize the effects of different anesthetic regimes and agents on ISM, causes of the failure of awake craniotomy and mapping, and outline the anesthetic considerations for ISM during awake craniotomy and asleep motor mapping.

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Intraoperative Myogenic Motor Evoked Potentials Induced by Direct Electrical Stimulation of the Exposed Motor Cortex Under Isoflurane and Sevoflurane

Cited by 9 publications

References 17 publications

Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data

Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data

Differential effects of nitrous oxide and propofol on myogenic transcranial motor evoked responses during sufentanil anaesthesia

Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists, Part 2: The Anesthetic Considerations

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