Comparison of the Effects of Propofol and Sevoflurane Combined With Remifentanil on Transcranial Electric Motor-evoked and Somatosensory-evoked Potential Monitoring During Brainstem Surgery

Hérnández-Palazón, J; Izura, Virginia; Fuentes-García, Diego; Piqueras-Pérez, Claudio; Doménech-Asensi, Paloma; Falcón-Araña, Luis

doi:10.1097/ana.0000000000000157

Cited by 27 publications

(14 citation statements)

References 22 publications

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“…SEPs provide an established modality for monitoring somatosensory pathway function during surgery on the spinal cord, brain, and brainstem to detect iatrogenic neurological injury, an effective indicator of brainstem integrity. However, SEPs are sensitive to anesthetic agents; thus, anesthetics may interfere with SEP recording [25].…”

Section: Discussionmentioning

confidence: 99%

New cutoffs for intraoperative somatosensory and motor evoked potentials during brain surgery

Yoon¹,

Park²,

Cha³

et al. 2022

J Intraoper Neurophysiol

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We aimed to identify the most reliable cutoff points for changes in somatosensory (SEPs) and motor (MEPs) evoked potentials to predict postoperative motor deterioration after brain surgery. The data of 104 patients who had undergone brain surgery between December 2015 and December 2016 were reviewed. The muscle strength evaluated on the day before, within 48 h and 4 weeks after surgery were reviewed. The sensitivity and specificity of the existing alarm criteria of intraoperative SEP and MEP for postoperative motor deterioration were evaluated, and receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoffs. The sensitivities of pre-existing SEPs and MEPs alarm criteria were 8.3% and 16.7%, with specificities of 96.7% and 95.7%, respectively. ROC curve analysis estimated discriminating points for latency change in SEPs and amplitude change in MEPs of 7.1% and 21.0%, respectively. With these cutoffs, the sensitivities of SEPs and MEPs were 66.7% and 91.7%, with specificities of 79.4% and 55.4%, respectively. For brain surgery, we suggest new alarm criteria with cutoff values of a 7.1% prolongation in SEP latency or a 21.0% reduction in MEP amplitude.

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Section: Discussionmentioning

confidence: 99%

New cutoffs for intraoperative somatosensory and motor evoked potentials during brain surgery

Yoon¹,

Park²,

Cha³

et al. 2022

J Intraoper Neurophysiol

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show abstract

“…In addition, muscle relaxants are known to have a significant effect on MEP monitoring and even make it impossible to perform. Although muscle relaxants were not used in this experiment except for anesthesia induction, sevoflurane and desflurane may have partial neuromuscular block effects under 0.9 MAC [ 25 ]; these effects are likely to influence MEP monitoring during operation. All patients studied had normal neurological examination; hence, these results may not be applicable to those with preexisting deficits.…”

Section: Discussionmentioning

confidence: 99%

Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked potential monitoring during neurosurgery: a randomized controlled trial

et al. 2021

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Background Better protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring. Methods A total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded. Results SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly. Conclusions SEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients studied had normal neurological examination findings, hence, these results may not be applicable to patients with preexisting deficits. Trial registration The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR2100045504 (18/04/2021).

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“…In previous studies, amplitude decreases > 50% or latency prolongation > 10% in SEPs and MEPs were regarded as having guiding clinical significance and were considered alert criteria. 27,28 However, there are false positive events during operation (eg, when alerts occur during surgery, but no organic injury to the limb nerves is observed after surgery) because monitoring results are influenced by many factors, and most alert events are caused by non-operative factors. To better confirm the guiding significance of electrophysiological monitoring indicators under the anaesthesia scheme considered in this study, the incidences of intraoperative alert events and false positive events will also be included as secondary outcome measures.…”

Section: Dovepressmentioning

confidence: 99%

Effects of Lidocaine on Motor-Evoked Potentials and Somatosensory-Evoked Potentials in Patients Undergoing Intraspinal Tumour Resection: Study Protocol for a Prospective Randomized Controlled Trial

Yue¹,

Zhou²,

Chong³

et al. 2022

JPR

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At present, it is believed that intravenous (IV) infusion of lidocaine can inhibit hyperalgesia, relieve postoperative acute and chronic pain, and accelerate the rehabilitation of patients. However, studies of its effects on necessary electrophysiological monitoring during neurosurgery are few, and the results are controversial. This study assumes that the propofol-remifentanil based anaesthesia combined with lidocaine in patients undergoing intraspinal tumour resection will not have adverse effects on motor-evoked potentials (MEPs) or somatosensory-evoked potentials (SEPs). Study Design and Methods: This is a prospective, randomized, placebo-controlled double-blind trial. A total of 96 patients undergoing intraspinal tumour resection will be randomly allocated to lidocaine and placebo group. The lidocaine group will receive IV lidocaine during anaesthesia, while the placebo group will receive the same dose of normal saline with the same infusion rate and infusion time, and the anaesthesia procedures of the two groups will be the same. All patients will be monitored the MEPs and SEPs of all four limbs during operation. The primary outcome will be the MEP amplitudes of both upper limbs at the end of operation. The secondary outcome measures will be the other electrophysiological parameters at the end of operation, the incidence of alert events for all four limbs, and the incidence of false positive events. Discussion: The purpose of this study is to evaluate the effects of IV infusion of lidocaine on SEPs and MEPs during intraspinal tumour resection to determine whether electrophysiological monitoring can accurately reflect the integrity of nerve functions while infusing lidocaine and to explore the possibility of lidocaine use during intraspinal tumour resection as an anaesthesia option.

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Comparison of the Effects of Propofol and Sevoflurane Combined With Remifentanil on Transcranial Electric Motor-evoked and Somatosensory-evoked Potential Monitoring During Brainstem Surgery

Abstract: Both sevoflurane and propofol at low dosages combined with remifentanil under comparable BIS values and partial muscle relaxation can be used when monitoring of TceMEPs and SSEPs is required for brainstem surgery.

Cited by 27 publications

References 22 publications

New cutoffs for intraoperative somatosensory and motor evoked potentials during brain surgery

New cutoffs for intraoperative somatosensory and motor evoked potentials during brain surgery

Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked potential monitoring during neurosurgery: a randomized controlled trial

Effects of Lidocaine on Motor-Evoked Potentials and Somatosensory-Evoked Potentials in Patients Undergoing Intraspinal Tumour Resection: Study Protocol for a Prospective Randomized Controlled Trial

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