Effect of ketamine on transcranial motor-evoked potentials during spinal surgery: a pilot study

Lam, Stephanie; Nagata, Masanori; Sandhu, Sonia K.; Veselis, Robert A.; McCormick, Patrick J.

doi:10.1016/j.bja.2019.09.005

Cited by 4 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lam et al reported no significant difference in repeated amplitude measurement during spinal surgery between ketamine (0.5 mg/kg loading followed by 0.2–0.5 mg/kg/h infusion) and dexmedetomidine (0.1–0.4 µg/k/h infusion) in their retrospective analysis on 35 adult patients. 13 In our study, intragroup analysis revealed that amplitude values for Groups D and S decreased significantly from baseline. In Group K, MEP amplitudes were maintained more or less similar to the baseline values.…”

Section: Discussionsupporting

confidence: 51%

Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Pathak,

Gupta,

Kaushal

et al. 2023

Asian J Neurosurg

View full text Add to dashboard Cite

Objectives Total intravenous anesthesia (TIVA) is used during surgery with intraoperative neurophysiological monitoring. Addition of adjuvant may minimize suppression of potentials by reducing doses of propofol. We studied the effect of addition of ketamine or dexmedetomidine to propofol–fentanyl-based TIVA on corticobulbar motor evoked potential (CoMEP) in patients undergoing posterior fossa surgeries. Materials and Methods Forty-two patients were assigned to three groups (n = 14 each), Group S—saline, Group D—dexmedetomidine (0.25 μg/kg/h), and Group K—ketamine (0.25 mg/kg/h). Patients received propofol and fentanyl infusions along with study drugs. CoMEPs were recorded from muscles innervated by cranial nerves bilaterally at predefined intervals (Tbaseline, T2, T3, T4, and T5). Effect on amplitude and latency of CoMEPs was assessed. Results A significant fall in CoMEP amplitude was observed across all analyzed muscles at time T4 and T5 in saline and dexmedetomidine group as compared with ketamine group, p-value less than 0.05. A significant increase in latency was observed at T4 and T5 among groups (p-value, D vs. K = 0.239, D vs. S = 0.123, and K vs. S = 0.001). Conclusion Both ketamine and dexmedetomidine provide and allow effective recording of CoMEPs. Ketamine emerges as a better agent especially when prolonged surgical duration is expected as even propofol–fentanyl-based TIVA adversely affects CoMEPs when used for long duration.

show abstract

Section: Discussionsupporting

confidence: 51%

Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Pathak,

Gupta,

Kaushal

et al. 2023

Asian J Neurosurg

View full text Add to dashboard Cite

show abstract

“…To our knowledge, only a retrospective study by Lam et al has compared the effects of ketamine and dexmedetomidine on MEPs during TIVA; no significant difference in amplitudes were observed with ketamine (0.5 mg/kg followed by 0.2–0.5 mg/kg/hr) and dexmedetomidine (0.1–0.4 μg/kg/hr without a loading dose) [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Effect of Continuous Infusion of Dexmedetomidine or a Subanesthetic Dose Ketamine on Transcranial Electrical Motor Evoked Potentials in Adult Patients Undergoing Elective Spine Surgery under Total Intravenous Anesthesia: A Randomized Controlled Exploratory Study

2022

View full text Add to dashboard Cite

Purpose: To compare effects of dexmedetomidine or a subanesthetic dose of ketamine on the amplitude and latency of transcranial electrically generated motor evoked potentials. Overview of Literature: Total intravenous anesthesia (TIVA) is a standard anesthesia technique for transcranial electrical motor evoked potential monitoring in spine surgery. We aimed to determine whether the use of dexmedetomidine and ketamine as a component of TIVA exerted any beneficial effect on the quality of monitoring. Methods: A total of 90 American Society of Anesthesiologist grade I-III patients, aged 18-65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 µg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol-fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation). Results: Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%-100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p<0.05). Conclusions:The present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.

show abstract

“…Ketamine increases muscle tone and could well be the reason for the ketofol induced increased amplitudes, as we did not administer muscle relaxant during maintenance of anesthesia [13]. Lam et al [14] observed that ketamine infusion (0.5 mg/kg bolus followed by 0.2-0.5 mg/kg/hr infusion) and dexmedetomidine (0.1-0.4 µg/kg/hr) had comparable effects on intraoperative TcMEP parameters during stable propofol-opioid anesthesia and suggested that ketamine is the preferred drug for major spinal surgeries. In an experimental study, three groups of rodents received either 75 mg/kg of intramuscular ketamine followed by IV infusion at 125 μg/kg/min or 10 mg/kg IV of propofol followed by IV infusion at 400 μg/kg/min (standard dose) or 800 μg/kg/min (high dose).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery

et al. 2022

View full text Add to dashboard Cite

The primary purpose was to compare the effects of propofol and ketofol on amplitudes and latencies of transcranial motor evoked potentials (TcMEPs) during thoracolumbar spine surgery. In addition, intraoperative hemodynamics and muscle power were compared. Overview of Literature: Propofol is commonly used during intraoperative TcMEP monitoring. However, propofol inhibits TcMEP amplitudes and causes hypotension in a dose-dependent fashion. Methods: Amplitude and latency of TcMEPs were recorded bilaterally from the abductor pollicis brevis (APB) and abductor hallucis (AH) muscles in 38 adult American Society of Anesthesiologists I and II patients undergoing thoracolumbar spine surgery. Baseline recordings of TcMEPs in both groups were recorded under propofol infusion. Group X patients then received propofol and fentanyl (1 mcg/ kg/hr), and group Y patients received ketofol and fentanyl (1 mcg/kg/hr). Bispectral index was maintained at 40-60 in both groups. Amplitude and latency were recorded at 30 minutes intervals for 2 hours. Results: Propofol caused no significant changes in amplitude and latency in any muscle. In contrast, amplitude increased significantly at all time points in the bilateral APB muscles and 60, 90, and 120 minutes in the left AH muscle without changes in latency in response to ketofol. When the two groups were compared, ketofol induced significantly higher amplitudes at 60, 90, and 120 minutes in the (left) APB, at all time points in the (right) APB, and at 120 minutes in both AH muscles, compared with propofol. Blood pressures were lower and fluid and vasopressor requirements were higher in group X. Muscle power was similar between the two groups. Conclusions: Ketofol facilitates TcMEP amplitudes without affecting latency. Use of ketofol resulted in a better and more stable hemodynamic profile than did use of propofol.

show abstract

Effect of ketamine on transcranial motor-evoked potentials during spinal surgery: a pilot study

Cited by 4 publications

References 13 publications

Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Evaluation of the Effect of Continuous Infusion of Dexmedetomidine or a Subanesthetic Dose Ketamine on Transcranial Electrical Motor Evoked Potentials in Adult Patients Undergoing Elective Spine Surgery under Total Intravenous Anesthesia: A Randomized Controlled Exploratory Study

Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery

Contact Info

Product

Resources

About