Intraoperative neurophysiological monitoring in neuroanesthesia

Nunes, Rogean Rodrigues; Bersot, Carlos Darcy Alves; Garritano, João G

doi:10.1097/aco.0000000000000645

Cited by 58 publications

(46 citation statements)

References 14 publications

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“…While it is thought that excessively deep anesthesia may impair mTc-MEP signals, and thereby may cause a false positive decrease of an mTc-MEP amplitude, few studies have investigated the influence of anesthetic depth on mTc-MEPs [17,29]. Some studies have investigated the effect of increasing the target propofol effect site concentration (Ce) on mTc-MEP amplitude and thresholds.…”

Section: Discussionmentioning

confidence: 99%

“…The latter is done by administration of fluids and vasopressors such as noradrenaline. Noradrenaline increases blood pressure, but also increases vascular resistance and therefore might even decrease tissue perfusion [10,28,29]. It is currently unknown what the exact effects of vasopressor-induced elevation of blood pressure is on mTc-MEPs in humans.…”

Section: Introductionmentioning

confidence: 99%

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The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

Dulfer

Sahinovic

Lange

et al. 2021

J Clin Monit Comput

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For high-risk spinal surgeries, intraoperative neurophysiological monitoring (IONM) is used to detect and prevent intraoperative neurological injury. The motor tracts are monitored by recording and analyzing muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs). A mTc-MEP amplitude decrease of 50–80% is the most common warning criterion for possible neurological injury. However, these warning criteria often result in false positive warnings. False positives may be caused by inadequate depth of anesthesia and blood pressure on mTc-MEP amplitudes. The aim of this paper is to validate the study protocol in which the goal is to investigate the effects of depth of anesthesia (part 1) and blood pressure (part 2) on mTc-MEPs. Per part, 25 patients will be included. In order to investigate the effects of depth of anesthesia, a processed electroencephalogram (pEEG) monitor will be used. At pEEG values of 30, 40 and 50, mTc-MEP measurements will be performed. To examine the effect of blood pressure on mTc-MEPs the mean arterial pressure will be elevated from 60 to 100 mmHg during which mTc-MEP measurements will be performed. We hypothesize that by understanding the effects of depth of anesthesia and blood pressure on mTc-MEPs, the mTc-MEP monitoring can be interpreted more reliably. This may contribute to fewer false positive warnings. By performing this study after induction and prior to incision, this protocol provides a unique opportunity to study the effects of depths of anesthesia and blood pressure on mTc-MEPs alone with as little confounders as possible.Trial registration number NL7772.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

Dulfer

Sahinovic

Lange

et al. 2021

J Clin Monit Comput

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“…The third possible reason for negative mapping is represented by anaesthesia, which has an important role in obtaining the proper result after stimulation. Special protocols have been used in order to avoid the medication that causes muscle relaxation which is associated with false negative recordings [16,18,26]. Those agents (Lystenon®) were used by our anaesthesia team, in general, at the induction step of the orotracheal intubation, just to facilitate the procedure.…”

Section: Discussionmentioning

confidence: 99%

The impact and causes of negative cortical mapping in primary motor area tumours

Coșman¹,

Iliescu²,

Sava³

et al. 2021

roneuro

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Introduction: Intraoperative neurophysiological monitoring is the golden standard for lesions located in eloquent areas of the brain. On the one hand, positive mapping offers a view of the relationship between the anatomo-functional cortical organisation of the patient and the lesion, facilitating the choice of the cerebrotomy entry point and the resection until the functional borders are found. On the other hand, negative mapping does not offer certainty that the absence of the motor response, from the operative field, is the real feedback or is the result of the false-negative response. In such a situation, a differentiation between those two must be done. Materials and methods: We evaluated the results of direct cortical stimulation of lesion located in or near the primary motor area, which were diagnosticated with contrast-enhancement head MRI and admitted to the Third Department of Neurosurgery, "Prof. Dr N. Oblu” Emergency Clinical Hospital, Iasi, Romania, between January 2014 and July 2018. Special attention was given especially to the negative mapping cases, regarding the histological type, imagistic localisation, symptoms and neurological outcome immediate postoperative, at 6 months and one-year follow-up. Results: From all 66 patients meeting the inclusion and exclusion criteria in 9,09% (6 cases) we did not obtain any motor response after direct cortical stimulation. The imagistic localisations of those cases were: 3 – Rolandic, 2 – pre-Rolandic and one retro-Rolandic. Tumors histological types were: glioblastoma, anaplastic astrocytoma, oligoastrocytoma and oligodendroglioma each one case and two cases of fibrillary astrocytoma. The intensity range was between 6 – 18mA, the mode – 12mA and the median – 10mA. Postoperatively the neurological condition of 3 patients worsened (4,54% from all the cases), while 3 had a favourable evolution with symptom remission. At 6monts and one-year follow-up in one case (1,51%), we observed no improvement in contrast with the other two, where dysfunction remission was highlighted. Conclusion: The possible technical, surgical and anesthesiologic causes of false-negative motor response must be eliminated to be able to differentiate from the real absence of the functional area from the operative field. In the first scenario, the resection may be associated with permanent postoperative neurologic deficit and major life quality alteration while in the second one the patient presents no motor dysfunction after surgery and the resection may be extensive with multiple oncological benefits.

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“…Inhalational anesthetics have a smaller impact on several parameters than do intravenous anesthetics. However, they increase the latency and reduce the amplitude [4]. Herein, we report four patients who underwent inhalational anesthesia because of cardiovascular disease, with IONM during the operation.…”

Section: Introductionmentioning

confidence: 96%

Intraoperative neurophysiological monitoring for inhalational anesthesia based on the minimum alveolar concentration level

Park¹,

Kim²,

Kim³

et al. 2019

J Intraoper Neurophysiol

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Total intravenous anesthesia (TIVA) is regard as a gold standard for intraoperative neurophysiological monitoring (IONM). Meanwhile, TIVA could induce a substantial reduction of cerebral blood volume and affect to hemodynamic and cardiovascular parameters. Inhalational anesthetics have relatively smaller impact on patients than intravenous anesthesia. But it could affect IONM modality especially in motor evoked potentials (MEP). We experienced four cases with inhalational anesthesia in IONM. According to minimum alveolar concentration (MAC) level, the amplitude of MEP changed. In 1.0 MAC, the wave form of MEP were not recognizable. But when we maintained total MAC of 0.5, we could obtain reliable MEPs and SSEPs. Inhalational anesthetics could inhibit the pyramidal activation of spinal motor neurons and synaptic transmission in the cerebral cortex. Based on our experiences, in the case with unstable hemodynamic state or contraindication to intravenous anesthesia, inhalational anesthesia with MAC 0.5 could be an alternative option.

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Intraoperative neurophysiological monitoring in neuroanesthesia

Cited by 58 publications

References 14 publications

The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

The impact and causes of negative cortical mapping in primary motor area tumours

Intraoperative neurophysiological monitoring for inhalational anesthesia based on the minimum alveolar concentration level

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