Influence of propofol concentrations on multipulse transcranial motor evoked potentials

Nathan, Nathalie; Tabaraud, F; Lacroix, F.; Mouliès, D.; Viviand, X.; Lansade, A; Terrier, G; Feiss, P.

doi:10.1093/bja/aeg211

Cited by 94 publications

(46 citation statements)

References 19 publications

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“…32 Opioids have little effect on evoked responses while still providing anesthesia. Propofol has a dose-dependent depressive effect on MEPs 19,26,36 but is routinely used in moderate doses in adult patients during spinal cord monitoring of the motor pathways. 15,29,31 The loss or absence of MEP amplitude may be minimized when propofol is administered in small, titrated doses (100-250 mg/kg/min) in a child younger than 3 years of age.…”

Section: Anesthesiamentioning

confidence: 99%

Intraoperative monitoring of motor evoked potentials in very young children

Fulkerson

Satyan

Wilder

et al. 2011

PED

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Object Neurophysiological monitoring of motor evoked potentials (MEPs) during complex spine procedures may reduce the risk of injury by providing feedback to the operating surgeon. While this tool is a well-established surgical adjunct in adults, clinical data in children are sparse. The purpose of this study was to determine the reliability and safety of MEP monitoring in a group of children younger than 3 years of age undergoing neurosurgical spine procedures. Methods A total of 10 consecutive spinal procedures in 10 children younger than 3 years of age (range 5–31 months, mean 16.8 months) were analyzed between January 1, 2008, and May 1, 2010. Motor evoked potentials were elicited by transcranial electric stimulation. A standardized anesthesia protocol for monitoring consisted of a titrated propofol drip combined with bolus dosing of fentanyl or sufentanil. Results Motor evoked potentials were documented at the beginning and end of the procedure in all 10 patients. A mean baseline stimulation threshold of 533 ± 124 V (range 321–746 V) was used. Six patients maintained MEP signals ≥ 50% of baseline amplitude throughout the surgery. There was a greater than 50% decrease in intraoperative MEP amplitude in at least 1 extremity in 4 patients. Two of these patients returned to baseline status by the end of the case. Two patients had a persistent decrement or variability in MEP signals at the end of the procedure; this correlated with postoperative weakness. There were no complications related to the technique of monitoring MEPs. Conclusions A transcranial electric stimulation protocol monitoring corticospinal motor pathways during neurosurgical procedures in children younger than 3 years of age was reliably and safely implemented. A persistent intraoperative decrease of greater than 50% in this small series of 10 pediatric patients younger than 3 years of age predicted a postoperative neurological deficit. The authors advocate routine monitoring of MEPs in this pediatric age group undergoing neurosurgical spine procedures.

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Section: Anesthesiamentioning

confidence: 99%

Intraoperative monitoring of motor evoked potentials in very young children

Fulkerson

Satyan

Wilder

et al. 2011

PED

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“…In the study of Nathan et al in the patients with scoliosis, whom they followed-up, propofol administered by target-controlled infusion decreased the amplitudes of tcMEPs, in a dose-dependent manner. 19 The authors also claimed that it is important to know well about these effects of propofol before surgery, with regard to the accurate evaluation of tcMEP responses. In a study performed on anaesthesia in scoliosis surgery, lidocaine was added to the propofol infusion in order to decrease the concentration levels of propofol, and cortical SSEPs and tcMEPs were found not to differ significantly.…”

Section: Resultsmentioning

confidence: 99%

A comparison of the effects of desflurane and total intravenous anaesthesia on the motor evoked responses in scoliosis surgery

Isik¹,

Turan

Abitağaoğlu

et al. 2017

Int J Res Med Sci

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Background: In the present study, we compared the effects of total intravenous anaesthesia (TIVA) and desflurane anaesthesia on tcMEPs in scoliosis surgery.Methods: The study included 45 patients between the ages of 18 to 50 years, and classified as ASAI-II; which were planned to undergo posterior fusion/instrumentation operations for elective scoliosis. Anaesthesia was maintained using 50-150 mcg/kg/min propofol in Group T(TIVA), and desflurane (0.5 MAC) in Group D, and with infusions of 0.05-0.3 mcg/kg/min remifentanil at 50 % O2 + air in both groups, by applying drugs at doses so that bispectral index (BIS) would be maintained between 40 and 60 throughout the course of anaesthesia. The tcMEP responses were measured four times during the operation, and BIS, train-of-four (TOF), mean arterial pressure (MAP), heart rate(HR), and end tidal CO2(ETCO2) values were recorded simultaneously. In both group the anaesthesia was ended at the final surgical suture. The recovery parameters were recorded.Results: The groups were found not to differ regarding the demographic characteristics, duration of the anaesthesia and the surgery, remifentanil dosage, tcMEP, the simultaneously recorded TOF, MAP, HR and ETCO2 values, and the amount of perioperative bleeding. The cooperation time and the orientation time were shorter in group D. The tcMEP responses were recorded in the appropriate times and amplitudes in both groups. Conclusions: TIVA is primarily used in routine applications in spinal surgery; however our study results revealed that 0.5 MAC desflurane may also be safely used in association with remifentanil, with the resultant correct tcMEP responses.

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“…Although propofol does demonstrate a dose-dependent reduction in MEP amplitude without effect on latency, 12 it has repeatedly been shown to produce a more stable neurophysiological environment for monitoring, when compared with inhalational anesthetics. [21][22][23][24] Opioids have shown minimal influence on MEP recording, and administered as a continuous infusion, are an invaluable part of an anesthetic regimen for spine surgery requiring neurophysiological monitoring. More recently, interest has been shown in using ketamine and dexmedetomidine as part of a TIVA regimen.…”

Section: Resultsmentioning

confidence: 99%

Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature

Wang¹,

Than²,

Etame³

et al. 2009

FOC

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Object Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential. Methods A literature search of the National Library of Medicine database was conducted to identify articles pertaining to anesthesia and TcMEP monitoring during spine surgery. Twenty studies were selected and reviewed. Results Inhalational anesthetics and neuromuscular blockade have been shown to limit the ability of TcMEP monitoring to detect significant changes. Hypothermia can also negatively affect monitoring. Opioids, however, have little influence on TcMEPs. Total intravenous anesthesia regimens can minimize the need for inhalational anesthetics. Conclusions In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.

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Influence of propofol concentrations on multipulse transcranial motor evoked potentials

Abstract: We found that, although propofol had a dose-dependent effect on tcMEP amplitude, anaesthesia could be maintained with remifentanil and propofol to allow recording and interpretation of tcMEP signals.

Cited by 94 publications

References 19 publications

Intraoperative monitoring of motor evoked potentials in very young children

Intraoperative monitoring of motor evoked potentials in very young children

A comparison of the effects of desflurane and total intravenous anaesthesia on the motor evoked responses in scoliosis surgery

Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature

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