Transcranial motor evoked potentials during anesthesia with desflurane versus propofol – A prospective randomized trial

Malcharek, Michael J.; Loeffler, S.; Schiefer, Daniel; Manceur, M.A.; Sablotzki, Armin; Gille, Jochen; Pilge, Stefanie; Schneider, Gerhard

doi:10.1016/j.clinph.2014.11.025

Cited by 46 publications

(24 citation statements)

References 49 publications

(60 reference statements)

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“…Therefore, for practical purpose, volatile anesthetics should be kept at no more than half the minimum anesthetic concentration (MAC). 78, 79 Isoflurane at concentrations of 0.75 and 1.0 MAC produce good MEP responses in only 61% and 8% of the patients, respectively after multi-pulse transcranial electrical stimulation. 80–82 Similarly, sevoflurane at 0.5 and 0.75 MAC produce adequate responses in only 55% and 10% of the patients, respectively, when using dual-pulse electrical stimuli.…”

Section: Spinal Cord Monitoring During Tevarmentioning

confidence: 98%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

104

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Purpose Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysmal and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors, pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. Source Articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia. Principal findings Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced compared to open TAAA repair. However, compared to open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and remains not fully understood though the evolving concept of the importance of the spinal cord’s collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most current spinal cord protection strategies. Conclusion Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for protection and treatment of SCI following TEVAR.

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Section: Spinal Cord Monitoring During Tevarmentioning

confidence: 98%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

104

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“…intraoperative muscle relaxants following intubation has been suggested as the preferred anaesthetic technique for these surgeries. [8] However, there has been a growing body of evidence on the ability to perform intraoperative MEP monitoring with the use of either inhalational anaesthesia alone [9] or balanced anaesthesia (BA) (intravenous [IV] anaesthesia and inhalational anaesthesia). [10] The potential benefits include decreased patient movement, increased haemodynamic stability and faster wake-up times.…”

Section: Introductionmentioning

confidence: 99%

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

Royan

Manninen

et al. 2017

Journal of Neuroanaesthesiology and Critical Care

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Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (<0.5 minimum alveolar concentration [MAC]) was used in 85% BA cases. Intraoperative neuromonitoring changes occurred in 11.8% (18/152) of cases. There was no statistical difference in the incidence of monitoring changes between BA (78%) and TIVA (22%) groups (P = 0.197). Anaesthetic or surgical interventions were performed in 12 patients, with a resolution of changes in 50% (P = 0.455). All 5 patients with persistent MEP changes had worsening of existing neurological deficits postoperatively; 8 had transient MEP changes, and 2 experienced worsening of existing neurological deficits. Conclusions: We found that intraoperative neurophysiological monitoring can be performed with both BA (MAC <0.5) and TIVA in high-risk spinal surgery with no statistical difference in the incidence of intraoperative monitoring changes.

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“…In contrast to our findings Malcharek et al observed decreased amplitudes in the desflurane group (MAC 0.5-0.6) compared with the propofol group. 12 In this prospective study, they evaluated the differences in tcMEP amplitudes between desflurane/remifentanil and propofol/remifentanil in patients without pre-existing motor deficits (PMDs) undergoing carotid endarterectomy (CEA) and concluded that desflurane reduced the tcMEP amplitude more significantly than propofol in patients without PMDs. They also concluded that in patients with initially small amplitudes, desflurane could limit tcMEP recording because it produced a remarkable amplitude reduction, even in patients without PMDs.…”

Section: Discussionmentioning

confidence: 99%

“…11 In contrast, another study stated that desfluarne (MAC of 0.5-0.6) could significantly decrease the motor evoked potential amplitude when compared with propofol. 12 In recent years, a lot of adjuvants along with TIVA have been tried. [13][14][15] Dexmedetomidine, an α 2 agonist, has been tried because of potentiation of the hypnotic effects of propofol while reducing the dose required.…”

Section: Introductionmentioning

confidence: 99%

Effect of Two Anesthetic Regimes with Dexmedetomidine as Adjuvant on Transcranial Electrical Motor Evoked Potentials during Spine Surgery

Mishra

Prabhakar

Kapoor

et al. 2020

Journal of Neuroanaesthesiology and Critical Care

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Background Transcranial motor evoked potential (TcMEP) recording during spinal cord/spinal column surgery is a reliable and valid diagnostic adjunct to assess spinal cord integrity and is recommended if utilized for this purpose. Electrophysiologic monitoring in terms of TcMEP has been proven to be a useful tool in detecting spinal cord dysfunction at the earliest and allows corrective action to be taken before permanent neuronal dysfunction sets in. The quality of intraoperative neuromonitoring is influenced by various factors. Most anesthetics used in clinical practice suppress the evoked potentials. Thus, selecting an appropriate technique is always a challenging task. Materials and Methods Thirty ASA I and II patients scheduled for elective dorsolumbar spine surgery with TcMEP monitoring were recruited in the study. Patients were randomized into three groups: (1) Propofol (group P) 100 to 150 µg/kg/min with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, (2) desflurane (group D) (<0.5 MAC) with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, and (3)standard group (group S) patients received propofol 100 to 150 µg/kg/min, fentanyl 1 µg/kg/hr along with equal volume of saline (placebo). TcMEP amplitudes were recorded bilaterally from electrodes placed at least in one set of muscles with motor origin rostral and one set of muscle caudal to the spinal level of lesion at different time points. Results Three patients were excluded after allocation; 27 out of 30 patients were analyzed. The demographic and surgical characteristics of patients were comparable. The stimulation voltage needed to elicit the responses in all the three groups was comparable. No difference was observed in brachioradialis muscle amplitudes between the groups at different time points. However, in the right brachioradialis muscle, we found reduced amplitudes at baseline in group D and at 120 minutes in group P. We noticed reduced amplitudes of bilateral brachioradialis muscle in group P at 60 minutes and 90 minutes with respect to the baseline. For lower extremity, we measured amplitudes of TcMEP in tibialis anterior (TA) and did not find any difference in amplitudes between the groups at different time points. Conclusion We observed that the desflurane–dexmedetomidine combination did not hinder TcMEP as compared with both standard and propofol–dexmedetomidine groups. Thus, this combined regime could be used in surgeries requiring motor evoked potential monitoring.

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Transcranial motor evoked potentials during anesthesia with desflurane versus propofol – A prospective randomized trial

Cited by 46 publications

References 49 publications

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Spinal cord injury after thoracic endovascular aortic aneurysm repair

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

Effect of Two Anesthetic Regimes with Dexmedetomidine as Adjuvant on Transcranial Electrical Motor Evoked Potentials during Spine Surgery

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