The effect of dexmedetomidine on motor-evoked potentials during pediatric posterior spinal fusion surgery: a retrospective case-control study

Holt, Francesca; Strantzas, Samuel; Zaarour, Christian; Chamlati, Racha; Vreugdenhil, Ian; Luginbuehl, Igor; Karsli, Cengiz; Faraoni, David

doi:10.1007/s12630-020-01758-6

Cited by 13 publications

(22 citation statements)

References 16 publications

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“…The effect of dexmedetomidine on intraoperative MEPs remains controversial, although a nonspecific reduction of amplitude or delayed latency of MEPs has been reported in brain tumor surgery 4 and spinal fusion surgery. 5 These false-positive results could negatively impact the outcome of the surgery, as they may prevent a sufficient resection margin of the tumor.…”

Section: Feasibility Of Awake Craniotomy In the Pediatric Populationmentioning

confidence: 99%

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Feasibility of awake craniotomy in the pediatric population

García‐Tejedor

Strantzas

Der

2020

Pediatric Anesthesia

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exposure to the SARS-Corona virus due to aerosol generation were much lower with suction, administration of oxygen, or manual ventilation compared to airway intubation. 3 We therefore suggest that natural airway sedation is an attractive option in some of these patients, and sedation/anesthesia providers should consider the option of natural airway sedation for imaging and other minor procedures rather than general endotracheal anesthesia in order to reduce aerosol particle generation during the COVID-19 pandemic. Monitoring via nasal cannula with end-tidal CO2 (EtCO2) detection capacity should still be used and a regular isolation mask applied to over this nasal cannula. Other advantages that associated with this technique in well-organized sedation programs include shorter duration of sedation, faster recovery, and prompt discharge of the patient which ultimately results in decreased exposure of staff to the patient and lower healthcare cost and resource utilization. 4 Furthermore, we advocate for a telehealth prescreening evaluation and subsequent multi-disciplinary discussion among the sedation team to ensure optimal patient selection and risk stratification. We suggest the exclusion of high-risk patients such as those with difficult airways, respiratory distress, copious secretions, American Society of Anesthesiologists-Physical Status classification >3, and history of previous anesthesiology consultation. We also urge anesthesia/sedation providers to strictly adhere to guidelines from the Centers for Disease Control (endorsed by ASA, AANA, APSF) on PPE, N95, and other institution dependent infection control measures to decrease transmission of COVID-19 even if natural airway sedation is performed. 5

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Section: Feasibility Of Awake Craniotomy In the Pediatric Populationmentioning

confidence: 99%

“…We also urge anesthesia/sedation providers to strictly adhere to guidelines from the Centers for Disease Control (endorsed by ASA, AANA, APSF) on PPE, N95, and other institution dependent infection control measures to decrease transmission of COVID-19 even if natural airway sedation is performed. 5…”

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confidence: 99%

Feasibility of awake craniotomy in the pediatric population

García‐Tejedor

Strantzas

Der

2020

Pediatric Anesthesia

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“…So, dexmedetomidine has been increasingly used as an adjuvant to general anesthesia (Deiner et al, 2017;Silva-et al, 2019). However, effects of dexmedetomidine on SSEP and MEP remain a topic of hot debate (Endrit Bala et al, 2008;Tobias et al, 2008;Mahmoud et al, 2010;Rozet et al, 2015;Holt et al, 2020). Some authors demonstrated that dexmedetomidine does not influence IONM parameters when delivered by a loading dose and then followed by a constant infusion rate in adults (Lin et al, 2014;Rozet et al, 2015) and adolescents (Tobias et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…Some authors demonstrated that dexmedetomidine does not influence IONM parameters when delivered by a loading dose and then followed by a constant infusion rate in adults (Lin et al, 2014;Rozet et al, 2015) and adolescents (Tobias et al, 2008). However, some authors demonstrated that dexmedetomidine administration can exert inhibitory effects on IONM (Mohamed Mahmoud et al, 2017;Holt et al, 2020). Moreover, dexmedetomidine enhances inhibitory synaptic transmission through activation of descending noradrenergic (NA) system (Yan Lu, 2007;Yusuke Funai a and Anthony, 2014).…”

Section: Introductionmentioning

confidence: 99%

A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study

Liu

Qin

et al. 2022

Front. Pharmacol.

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Background: The effect of a bolus dose of dexmedetomidine on intraoperative neuromonitoring (IONM) parameters during spinal surgeries has been variably reported and remains a debated topic.Methods: A randomized, double-blinded, placebo-controlled study was performed to assess the effect of dexmedetomidine (1 μg/kg in 10 min) followed by a constant infusion rate on IONM during thoracic spinal decompression surgery (TSDS). A total of 165 patients were enrolled and randomized into three groups. One group received propofol- and remifentanil-based total intravenous anesthesia (TIVA) (T group), one group received TIVA combined with dexmedetomidine at a constant infusion rate (0.5 μg kg−1 h−1) (D1 group), and one group received TIVA combined with dexmedetomidine delivered in a loading dose (1 μg kg−1 in 10 min) followed by a constant infusion rate (0.5 μg kg−1 h−1) (D2 group). The IONM data recorded before test drug administration was defined as the baseline value. We aimed at comparing the parameters of IONM.Results: In the D2 group, within-group analysis showed suppressive effects on IONM parameters compared with baseline value after a bolus dose of dexmedetomidine. Furthermore, the D2 group also showed inhibitory effects on IONM recordings compared with both the D1 group and the T group, including a statistically significant decrease in SSEP amplitude and MEP amplitude, and an increase in SSEP latency. No significance was found in IONM parameters between the T group and the D1 group.Conclusion: Dexmedetomidine delivered in a loading dose can significantly inhibit IONM parameters in TSDS. Special attention should be paid to the timing of a bolus dose of dexmedetomidine under IONM. However, dexmedetomidine delivered at a constant speed does not exert inhibitory effects on IONM data.

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“…[ 15 , 16 ] Whereas dosage above 0.4 μg/(kg·h) were accompanied with increased side effects such as decreased motor evoked potentials. [ 17 , 18 ] Furthermore, the critically ill patients the kind we included in this study, SOSCS was a long procedure that would result in an increased accumulative dosage. This could be challenging in terms of side effects or complications.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine dosage in critically ill patients undergoing intraoperative wake-up test

et al. 2022

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Objective:The aim of this study was to find the optimum dosage of dexmedetomidine in Spinal Orthopedic Scoliosis Correction Surgery when used in combination with propofol and remifentanil in American Society of Anesthesiologists (ASA) III patients with severe scoliosis undergoing intraoperative wake-up test.Materials and methods:We selected a total of 60 ASA III ≤40 years old patients who underwent Spinal Orthopedic Scoliosis Correction Surgery (SOSCS) and randomized them into groups A, B, and C. Group A was administered 0.2 μg/(kg·h) of dexmedetomidine, group B 0.3 μg/(kg·h), and group C 0.4 μg/(kg·h). The main parameters monitored were: wake-up time; wake-up quality; adverse effects that occur while the patient is awake; postoperative awareness of intraoperative wake-up test; heart rate (HR); mean arterial pressure (MAP); and oxygen saturation (SpO2). Values of these parameters were monitored at 7 timestamps separated by 5 minutes >30 minutes.Results:Group B had a higher MAP at 10 minutes before wake-up (P = .03) and at the moment of wake-up (P = .04) than group A. The Wake-up time of group A was 14.95 ± 7.42 minutes, group B was 14.7 ± 6.52 minutes, which was significantly shorter than that of group C 21.3 ± 10.02 minutes (P = .02). The wake-up quality was excellent. All other parameters had no significant statistical differences.Conclusion:Doses of 0.2 to 0.3 μg/(kg·h) have shorter wake-up time and fewer hemodynamic fluctuations compared to 0.4 μg/(kg·h).

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The effect of dexmedetomidine on motor-evoked potentials during pediatric posterior spinal fusion surgery: a retrospective case-control study

Cited by 13 publications

References 16 publications

Feasibility of awake craniotomy in the pediatric population

Feasibility of awake craniotomy in the pediatric population

A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study

Dexmedetomidine dosage in critically ill patients undergoing intraoperative wake-up test

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