Effects of Midazolam on Median Nerve Somatosensory Evoked Potentials

Sloan, Tod B.; Fugina, M. L.; Toleikis, J. Richard

doi:10.1093/bja/64.5.590

Cited by 79 publications

(19 citation statements)

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“…[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%

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: 99%

Reliability of perioperative SSEP recordings in spine surgery

et al. 2003

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“…Is-21 In addition, latencies of subcortical and cortical responses of the somatosensory evoked potentials (SSEP) remain unchanged with benzodiazepines. [20][21][22][23][24] demonstrated that midazolam produced a depression of cortical SSEP amplitude without alterations in latency. 24 In contrast to the benzodiazepines, the influence of general anaesthesia on MLAEP has been well studied for the volatile anaesthetic agents isoflurane, enflurane and halothane, so.,I With volatile anaesthetics, brainstem components of the auditory evoked potential are only slightly prolonged in latency.…”

Section: Discussionmentioning

confidence: 99%

Effects of benzodiazepines on mid-latency auditory evoked potentials

Schwender¹,

Klasing²,

Madler³

et al. 1993

Can J Anaesth

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Midlatency auditory evoked potentials (MLAEP) reflect primary cortical processing of auditory stimuli. The effects of benzodiazepines on MLAEP have not yet been studied. We examined the effects of intravenous induction of general anaesthesia using the benzodiazepines midazolam, diazepam and flunitrazepam on MLAEP in 30 patients scheduled for minor gynaecological procedures. Anaesthesia was induced with Group L n = 10), Group II, Group Ill, n = 10 (0, groupe I, n = 10), le diazdpam (0, group II, n = 10) ou le flunitrazepam (0, groupe IlI, n = 10

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“…However, in daily clinical practice, neurological examination will be performed after wearing off of sedative drugs and before requesting a SEP. Furthermore, sedative drugs such as propofol or midazolam only seem to cause marginal effects on latency and amplitude of the cortical N20 responses [26–28]. …”

Section: Discussionmentioning

confidence: 99%

Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma

et al. 2011

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Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) predicts poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation (CPR). Although SEP is easy to perform and available in most hospitals, it is worthwhile to know how neurological signs are associated with SEP results. The aim of this study was to investigate whether specific clinical neurological signs are associated with either an absent or a present median nerve SEP in patients after CPR. Data from the previously published multicenter prospective cohort study PROPAC (prognosis in postanoxic coma, 2000–2003) were used. Neurological examination, consisting of Glasgow Coma Score (GCS) and brain stem reflexes, and SEP were performed 24, 48, and 72 h after CPR. Positive predictive values for predicting absent and present SEP, as well as diagnostic accuracy were calculated. Data of 407 patients were included. Of the 781 SEPs performed, N20 s were present in 401, bilaterally absent in 299, and 81 SEPs were technically undeterminable. The highest positive predictive values (0.63–0.91) for an absent SEP were found for absent pupillary light responses. The highest positive predictive values (0.71–0.83) for a present SEP were found for motor scores of withdrawal to painful stimuli or better. Multivariate analyses showed a fair diagnostic accuracy (0.78) for neurological examination in predicting an absent or present SEP at 48 or 72 h after CPR. This study shows that neurological examination cannot reliably predict absent or present cortical N20 responses in median nerve SEPs in patients after CPR.

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Effects of Midazolam on Median Nerve Somatosensory Evoked Potentials

Cited by 79 publications

References 0 publications

Reliability of perioperative SSEP recordings in spine surgery

Reliability of perioperative SSEP recordings in spine surgery

Effects of benzodiazepines on mid-latency auditory evoked potentials

Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma

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