Effects of Etomidate, Midazolam, and Thiopental on Median Nerve Somatosensory Evoked Potentials and the Additive Effects of Fentanyl and Nitrous Oxide

Koht, Antoun; Schütz, W; Schmidt, Géraldine; Schramm, Johannes; Watanabe, Eiju

doi:10.1213/00000539-198805000-00003

Cited by 117 publications

(40 citation statements)

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“…[22][23][24] However, the present findings reveal that by application of computer-assisted TIVA characteristic changes of early SSEP components can be predicted. This allows to distinguish changes of intraoperative SSEP parameters, which are not induced by the anesthesia.…”

Section: Discussionmentioning

confidence: 51%

“…[18][19][20]25 The influence of midazolam used for premedication can be neglected, as several studies showed no or only a transient effect on SSEP latencies. 22,26,27 Also the application of low doses of opioids (fentanyl) is not supposed to induce the predictable changes on SSEP latencies. 18,22,28 The intraoperative within-case variability of SSEP is of relevance in performing neuromonitoring during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…22,26,27 Also the application of low doses of opioids (fentanyl) is not supposed to induce the predictable changes on SSEP latencies. 18,22,28 The intraoperative within-case variability of SSEP is of relevance in performing neuromonitoring during surgery. [29][30][31] It is of importance to determine the range of SSEP variability, which can be expected due to specific protocols of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Reliability of perioperative SSEP recordings in spine surgery

et al. 2003

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Objective: The reproducibility and clinical reliability of perioperative somatosensory-evoked potentials (SSEP) were prospectively evaluated in uneventful scoliosis surgery. The influence of anesthesia owing to induction of total intravenous anesthesia (TIVA) upon preoperative SSEP and the variability of intraoperative SSEP were calculated. The potential effect of spine surgery was assessed by comparing pre-to postoperative SSEP. Methods: A total of 2143 pre-, intra-and postoperative tibial and median SSEP recorded in 25 patients undergoing spine surgery owing to idiopathic scoliosis were analyzed. The anesthesia protocol consisted of a computerized target controlled infusion (TCI) device for propofol and intravenous application of an opioid. Results: Anesthesia induced a significant and comparable prolongation of the tibial SSEP onset, P40 and P60 latencies, while the N50 latency was less changed. Throughout anesthesia, latencies of median (onset, N20, P25 and N35) and tibial (onset, P40, N50 and P60) SSEP showed mean variations of less than 6%. The intraoperative SSEP amplitudes were less stable with a relative standard deviation of 30-40%. In uneventful spine surgery, the postoperative tibial SSEP were not significantly changed in comparison to preoperative recordings. Conclusions: By using a standardized anesthesia protocol, the impact of anesthesia on preoperative SSEP can be predicted. Furthermore, the controlled application of sedatives and analgesics allows recording of stable SSEP parameters for intraoperative monitoring purposes. As in uneventful spine surgery pre-to postoperative SSEP are unchanged the latter comparison can be applied as an additional perioperative neuromonitoring procedure to assess the influence of spine surgery or other invasive interventions on spinal cord function.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reliability of perioperative SSEP recordings in spine surgery

et al. 2003

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“…In vivo studies have shown that primary somatosensory and auditory cortical sensory evoked potentials are variably affected by anesthetics. For example, the amplitude of the N20-P23 wave (representing the early primary cortical response) is consistently increased during etomidate anesthesia [2,19] . Evoked potential slope is not typically measured in clinical studies; however, an increase in population event amplitude is usually accompanied by an increase in event slope.…”

Section: Results From In Vivo Studiesmentioning

confidence: 99%

Cortico-centric effects of general anesthetics on cerebrocortical evoked potentials

Voss

Sleigh

2015

Neurosci. Bull.

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Despite their ubiquitous use for rendering patients unconscious for surgery, our understanding of how general anesthetics cause hypnosis remains rudimentary at best. Recent years have seen increased interest in "top-down" cortico-centric theories of anesthetic action. The aim of this study was to explore this by investigating direct cortical effects of anesthetics on cerebrocortical evoked potentials in isolated mouse brain slices. Evoked potentials were elicited in cortical layer IV by electrical stimulation of the underlying white matter. The effects of three anesthetics (ketamine, etomidate, and isofl urane) on the amplitude, latency, and slope of short-latency evoked potentials were quantified. The N2/P3/N4 potentials -which represent the early cortical response -were enhanced by etomidate (increased P3-N4 slope, P <0.01), maintained by ketamine, and reduced by isoflurane (lower N2/P3 amplitude, P <0.01). These effects closely resemble those seen in vivo for the same drugs and point to a cortical mechanism independent of effects on subcortical structures such as the thalamus.

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“…However, benzodiazepines do not result in marked changes in the amplitudes and latencies within the MLAEP [85], although midazolam (at high bolus doses) has been shown to produce transient attenuation of the MLAEP. Midazolam causes a decrease in amplitude without changes in latency of SSEPs [86].…”

Section: Influence Of Anaesthetic Drugs On Sepsmentioning

confidence: 94%

Evoked potential monitoring in anaesthesia and analgesia

2000

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SummaryElectrophysiological monitoring of selected neural pathways of the brain, brainstem, spinal cord and peripheral nervous system has become mandatory in some surgery of the nervous system where preventable neural injury can occur. Evoked potentials are relatively simple methods of testing the integrity of various aspects of the nervous system. This review covers the variety of evoked potentials that can be monitored and outlines the principles of their measurement. Their use in specific situations and how factors such as anaesthesia might affect them is presented.

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Effects of Etomidate, Midazolam, and Thiopental on Median Nerve Somatosensory Evoked Potentials and the Additive Effects of Fentanyl and Nitrous Oxide

Cited by 117 publications

References 0 publications

Reliability of perioperative SSEP recordings in spine surgery

Reliability of perioperative SSEP recordings in spine surgery

Cortico-centric effects of general anesthetics on cerebrocortical evoked potentials

Evoked potential monitoring in anaesthesia and analgesia

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