A comparison of the effects of desflurane versus propofol on transcranial motor-evoked potentials in pediatric patients

Holdefer, Robert N.; Anderson, Cole; Furman, Michele; Sangaré, Yoro; Slimp, Jefferson C.

doi:10.1007/s00381-014-2510-8

Cited by 24 publications

(10 citation statements)

References 21 publications

(26 reference statements)

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“…The observed effect appears to be more pronounced in myelopathic than neurologically normal patients, but the underlying mechanism responsible remains unclear. In contrast, Holdefer et al [ 7 ] reviewed MEP amplitudes of 50 patients receiving desflurane or propofol during spinal deformity surgery but found no evidence of reducing trend with time. This was corroborated by a separate study [ 8 ] which also found no significant MEP amplitude changes over 120 min during propofol anesthesia for spinal surgery.…”

Section: Introductionmentioning

confidence: 99%

Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery

Tan

Raman

et al. 2018

Scoliosis

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BackgroundMotor- (MEP) and somatosensory-evoked potentials (SSEP) are susceptible to the effects of intraoperative environmental factors.MethodsOver a 5-year period, 250 patients with adolescent idiopathic scoliosis (AIS) who underwent corrective surgery with IOM were retrospectively analyzed for MEP suppression (MEPS).ResultsOur results show that four distinct groups of MEPS were encountered over the study period. All 12 patients did not sustain any neurological deficits postoperatively. However, comparison of groups 1 and 2 suggests that neither the duration of anesthesia nor speed of surgical or anesthetic intervention were associated with recovery to a level beyond the criteria for MEPS. For group 3, spontaneous MEPS recovery despite the lack of surgical intervention suggests that anesthetic intervention may play a role in this process. However, spontaneous MEPS recovery was also seen in group 4, suggesting that in certain circumstances, both surgical and anesthetic intervention was not required. In addition, neither the duration of time to the first surgical manoeuver nor the duration of surgical manoeuver to MEPS were related to recovery of MEPS. None of the patients had suppression of SSEPs intraoperatively.ConclusionThis study suggests that in susceptible individuals, MEPS may rarely occur unpredictably, independent of surgical or anesthetic intervention. However, our findings favor anesthetic before surgical intervention as a proposed protocol. Early recognition of MEPS is important to prevent false positives in the course of IOM for spinal surgery.

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Section: Introductionmentioning

confidence: 99%

Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery

Tan

Raman

et al. 2018

Scoliosis

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“…Technical details of tcMEPs in children such as the optimal number of pulses during spine surgeries have been studied . The interactions between MEPs and various anesthetic agents have been studied, and MEPs are preserved in children who are administered either propofol or desflurane . In contrast, dexmedetomidine tends to attenuate tcMEP signals …”

Section: Resultsmentioning

confidence: 99%

Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement

et al. 2020

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Nerve conduction studies and needle electromyography, collectively known as electrodiagnostic (EDX) studies, have been available for pediatric patients for decades, but the accessibility of this diagnostic modality and the approach to testing vary significantly depending on the physician and institution. The maturation of molecular diagnostic approaches and other diagnostic technologies such as neuromuscular ultrasound indicate that an analysis of current needs and practices for EDX studies in the pediatric population is warranted. The American Association of Neuromuscular & Electrodiagnostic Medicine convened a consensus panel to perform literature searches, share collective experiences, and develop a consensus statement. The panel found that electrodiagnostic studies continue to have high utility for the diagnosis of numerous childhood neuromuscular disorders, and that standardized approaches along with the use of high-quality reference values are important to maximize the diagnostic yield of these tests in infants, children, and adolescents. K E Y W O R D S adolescents, children, electrodiagnostic medicine, electromyography, infants, neuromuscular disorders, pediatric

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“…We first determined if the anesthetic type altered evoked pressure (P det ) since some prior studies suggest that isoflurane may reduce sensory or motor evoked potentials [24, 25] and that propofol may reduce motor evoked potentials [26]. Five animals with intact bladder innervation were tested using isoflurane, and then propofol.…”

Section: Resultsmentioning

confidence: 99%

Acute bladder decentralization in hound dogs: Preliminary results of effects on hypogastric nerve electroneurograms and detrusor pressure responses to spinal root and hypogastric nerve stimulation

et al. 2019

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Objective We aimed to refine electroneurogram techniques for monitoring hypogastric nerve activity during bladder filling, and then examined nerve activity in normal intact versus acutely decentralized bladders. Methods Effects of electrical stimulation of hypogastric nerves or lumbar ventral roots on detrusor pressure were examined, as were effects of isoflurane versus propofol anesthetics on hypogastric nerve stimulation evoked pressure. Hypogastric nerve activity was then recorded using custom-made bipolar cuff electrodes during bladder filling before and after its transection between the spinal cord and electrode to eliminate efferent nerve signals. Results Electrical stimulation of hypogastric nerves evoked low amplitude detrusor pressures that did not differ between the two anesthetics. Upper lumbar (L2) ventral root stimulation evoked detrusor pressures were suppressed, yet not eliminated, after transection of hypogastric nerves and all spinal roots below L5. Afferent and efferent hypogastric nerve activity did not change with bladder filling in neuronally intact bladders yet decreased in decentralized bladders. No change in afferent activity was observed during bladder filling in either intact or decentralized bladders. Conclusions These findings indicate that a more complete decentralized bladder model should include transection of lumbosacral spinal roots innervating the bladder as well as hypogastric nerves. These refined electroneurogram recording methods may be suitable for evaluating the effectiveness of nerve transfer surgeries for bladder reinnervation by monitoring sensory activity in the transferred nerve.

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A comparison of the effects of desflurane versus propofol on transcranial motor-evoked potentials in pediatric patients

Cited by 24 publications

References 21 publications

Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery

Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery

Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement

Acute bladder decentralization in hound dogs: Preliminary results of effects on hypogastric nerve electroneurograms and detrusor pressure responses to spinal root and hypogastric nerve stimulation

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