Intraoperative Motor-evoked Potential Monitoring in Scoliosis Surgery: Comparison of Desflurane/Nitrous Oxide With Propofol Total Intravenous Anesthetic Regimens

Lo, Yew‐Long; Dan, Y.F.; Tan, Yan Zhi; Nurjannah, Siti; Tan, Seck Guan; Tan, Chao; Raman, Sitaram

doi:10.1097/01.ana.0000211007.94269.50

Cited by 61 publications

(31 citation statements)

References 19 publications

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“…During spinal surgery, monitoring MEP is a means of assessing the intraoperative integrity of corticospinal pathways [15]. Due to the limitation of the situations, intraoperative SSEP or MEPs was not monitored in our study.…”

Section: Discussionmentioning

confidence: 99%

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

et al. 2011

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Priority of neurological decompression was regarded as necessary for scoliosis patients associated with Chiari I malformation in order to decrease the risk of spinal cord injury from scoliosis surgery. We report a retrospective series of scoliosis associated with Chiari I malformation in 13 adolescent patients and explore the effectiveness and safety of posterior scoliosis correction without suboccipital decompression. One-stage posterior approach total vertebral column resection was performed in seven patients with scoliosis or kyphosis curve [90°(average 100.1°s coliotic and 97.1°kyphotic curves) or presented with apparent neurological deficits, whereas the other six patients underwent posterior pedicle screw instrumentation for correction of spinal deformity alone (average 77.3°s coliotic and 44.0°kyphotic curves). The apex of the scoliosis curve was located at T7-T12. Mean operating time and intraoperative hemorrhage was 463 min and 5,190 ml in patients undergoing total vertebral column resection, with average correction rate of scoliosis and kyphosis being 63.3 and 71.1%, respectively. Mean operating time and intraoperative hemorrhage in patients undergoing instrumentation alone was 246 min and 1,450 ml, with the average correction rate of scoliosis and kyphosis being 60.8 and 53.4%, respectively. The mean follow-up duration was 32.2 months. No iatrogenic neurological deterioration had been encountered during the operation procedure and follow-up. After vertebral column resection, neurological dysfunctions such as relaxation of anal sphincter or hypermyotonia that occurred in three patients preoperatively improved gradually. In summary, suboccipital decompression prior to correction of spine deformity may not always be necessary for adolescent patients with scoliosis associated with Chiari I malformation. Particularly in patients with a severe and rigid curve or with significant neurological deficits, posterior approach total vertebral column resection is likely a good option, which could not only result in satisfactory correction of deformity, but also decrease the risk of neurological injury secondary to surgical intervention by shortening spine and reducing the tension of spinal cord.

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Section: Discussionmentioning

confidence: 99%

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

et al. 2011

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“…Nevertheless, the choice and management of the anesthetic agents may impair the diagnosis of intraoperative spinal cord injury [23]. TcMEPs are significantly affected by the use of halogenated agents and nitrous oxide as well as the level of neuromuscular blockade because these agents affect the neural synaptic and axonal functional activities [23,24]. At an alveolar concentration (MAC) of 1.0 or higher, TcMEPs are often unobtainable.…”

Section: Discussionmentioning

confidence: 99%

Posterior approach to ventrally located spinal meningiomas

et al. 2010

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For the resection of anteriorly located meningiomas, various approaches have been used. Posterior approach is less invasive and demanding; however, it has been associated with increased risk of spinal cord injury. We evaluated ten consecutive patients that underwent surgery for spinal meningiomas. All patients were preoperative assessed by neurological examination, computed tomography and magnetic resonance imaging. All tumors were ventrally located and removed via a posterior approach. Transcranial motor-evoked potentials (TcMEPs), somatosensory-evoked potential (SSEP) and free running electromyography (EMG) were monitored intraoperative. Postoperative all patients had regular follow-up examinations. There were four males and six females. The mean age was 68.2 years (range 39-82 years). In nine out of ten cases, the tumor was located in the thoracic spine. A case of a lumbar meningioma was recorded. The most common presenting symptom was motor and sensory deficits and unsteady gait, whereas no patient presented with paraplegia. All meningiomas were operated using a microsurgical technique via a posterior approach. During the operation, free running EMG monitoring prompted a surgical alert in case of irritation, whereas TcMEP and SSEP amplitudes remained unchanged. Histopathology revealed the presence of typical (World Health Organisation grade I) meningiomas. The mean Ki-67/MIB-1 index was 2.75% (range 0.5-7). None of our patients sustained a transient or permanent motor deficit. After a mean follow-up period of 26 months (range 56-16 months), no tumor recurrence and no instability were found. Posterior approach for anteriorly located meningiomas is a safe procedure with the use of intraoperative monitoring, less invasive and well-tolerated especially in older patients. Complete tumor excision can be performed with satisfactory results.

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“…10 tcMEP responses are affected and inhibited by anaesthetic agents like neuromuscular blockers, inhalation anaesthetics, and nitrous oxide; however, these responses are known not to be affected by the TIVA method. 11,12 When inhalation anaesthetics were investigated, studies demonstrated that sevoflurane and isoflurane in particular depress the amplitudes of tcMEPs in a dose-dependent manner. 13,14 In a prospective study of Lo et al conducted with desflurane, one study group was administered desflurane anaesthesia, the other was applied TIVA (propofol), and both groups were also given morphine when required; in this study, the proper tcMEP responses were recorded in both groups.…”

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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Intraoperative Motor-evoked Potential Monitoring in Scoliosis Surgery: Comparison of Desflurane/Nitrous Oxide With Propofol Total Intravenous Anesthetic Regimens

Abstract: This is the first study comparing the use of desflurane and TIVA showing that both anesthetic regimens allowed successful intraoperative monitoring useage throughout the procedures. For MEP recording, the AH was the preferred muscle with a desflurane anesthetic regimen.

Cited by 61 publications

References 19 publications

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?

Posterior approach to ventrally located spinal meningiomas

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

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