Low Dose Propofol as a Supplement to Ketamine-Based Anesthesia During Intraoperative Monitoring of Motor-Evoked Potentials

Kawaguchi, Masahiko; Sakamoto, T.; Inoue, Satoki; Kakimoto, Meiko; Furuya, Hitoshi; Morimoto, Tetsuya; Sakaki, Toshisuke

doi:10.1097/00007632-200004150-00013

Cited by 75 publications

(32 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Anesthesiamentioning

confidence: 99%

Intraoperative monitoring of motor evoked potentials in very young children

Fulkerson

Satyan

Wilder

et al. 2011

PED

View full text Add to dashboard Cite

show abstract

“…For effective monitoring, clear, continuous communication between the surgical team, the neurologist, and the anesthesiologist is important. 15,16 This study considered any change in neuromonitoring to be a true positive and the information obtained by the examinations influenced the course of the surgery, in most cases causing the withdrawal and/or repositioning of the pedicle screws. This fact is supported by the greater surgical time and time per screw related to changes in the EMG.…”

Section: Contributions Of the Authorsmentioning

confidence: 99%

Electromyography and Instrumentation in Patients With Idiopathic Scoliosis

et al. 2017

View full text Add to dashboard Cite

Objective: The objective of this study is to relate the use of intraoperative electromyography with surgical time, proper placement of screws, type of curve and time spent per screw in idiopathic scoliosis correction surgery in a group of surgeons from Belo Horizonte. This study used the database of protocol evaluation of patients operated in the service, and separately analyzed the results of motor and somatosensory potentials. Methods: Retrospective study of 80 patients undergoing surgery for correction of idiopathic scoliosis between December 2008 and January 2015. A single group of Belo Horizonte spine surgeons performed the intraoperative electromyographic (EMG) monitoring. EMG was performed with stimulation of pedicle screws in patients undergoing instrumentation with pedicle screws as fixation elements. Results: The sample consisted of 85% females (mean age 17 years) and 37.5% of cases had classification type 1AN of Lenke. Of the total surgical cases, 60% had EMG changes. Of the total cases analyzed, 66.3% were true positives for the result. Conclusion: Intraoperative monitoring with EMG is a very important tool for the surgical treatment of patients with scoliosis undergoing instrumentation with pedicle screws. It enables to check if the screw is located on the correct path, helping to decrease the error rate and providing corrections to the surgical approach through a change of strategies. Moreover, it contributes to decrease the time to screw positioning and the total surgical time.

show abstract

“…[1][2][3][4][5][6][7][8][9][10] Therefore, anesthetic concentrations are generally not modified when MEP monitoring is used. In addition, these anesthetics are usually used at relatively low doses, and patients undergoing intraoperative MEP monitoring often demonstrate symptoms of light anesthesia in response to noxious stimuli during surgery.…”

Section: Résultats : L'amplitude Et La Latence Des Pem N'ont Pas Chanmentioning

confidence: 99%

“…In addition, these anesthetics are usually used at relatively low doses, and patients undergoing intraoperative MEP monitoring often demonstrate symptoms of light anesthesia in response to noxious stimuli during surgery. [1][2][3][4][5][6][7][8][9][10] Ideally, anesthesia for intraoperative MEP monitoring should not inhibit MEP monitoring and, simultaneously, should provide adequate anesthesia in response to surgical stimuli.…”

Section: Résultats : L'amplitude Et La Latence Des Pem N'ont Pas Chanmentioning

confidence: 99%

“…A train-of-five pulses with an interstimulus interval of 2 msec were used as in our previous study. 7 The outputs were delivered to the scalp by a single pair of 14.5 mm silver disc electrodes, applied to C3 (anode) and C4 (cathode); (international 10-20 system). Five consecutive stimulations at C3 and C4 were made.…”

Section: Résultats : L'amplitude Et La Latence Des Pem N'ont Pas Chanmentioning

confidence: 99%

See 1 more Smart Citation

Noxious stimuli do not modify myogenic motor evoked potentials by electrical stimulation during anesthesia with propofol-based anesthesia

Inoue

Kawaguchi

Takahashi

et al. 2003

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To investigate whether motor evoked potentials (MEP) to transcranial electrical stimulation under constant blood propofol concentration are affected by the arousing effect of surgical noxious stimuli.M Me et th ho od ds s: : Twenty patients who underwent elective spinal surgery were studied. Patients were anesthetized with 50% nitrous oxide in oxygen, fentanyl, and propofol to maintain the bispectral index (BIS) score around 50. MEP in response to a multipulse transcranial electrical stimulation at stimulus sites of C3-C4 were recorded over the right abductor pollicis brevis muscle. Changes of peak-topeak amplitude and onset latency of MEP, BIS score before and after surgical stimuli were evaluated. Propofol plasma concentration was measured at the same time points.R Re es su ul lt ts s: : Both MEP amplitude and latency did not change significantly after surgical stimuli although BIS increased significantly (48 ± 6 to 58 ± 5; P < 0.05). Plasma propofol concentration was maintained at the same level between the two measurement points (3.3 ± 0.7 to 3.3 ± 0.7 µg·mL -1). There was no relation between BIS change and changes of MEP amplitude and latency, and propofol plasma concentration.C Co on nc cl lu us si io on n: : MEP to the transcranial electrical stimulation under a constant and clinically appropriate blood propofol concentration are not affected by surgical noxious stimuli. Objectif : Découvrir si les potentiels évoqués moteurs (PEM) obtenus

show abstract

Low Dose Propofol as a Supplement to Ketamine-Based Anesthesia During Intraoperative Monitoring of Motor-Evoked Potentials

Abstract: If a train of pulses were used for transcranial stimulation, low-dose propofol can be effectivelyused as a supplement to ketamine-based anesthesia during intraoperative monitoring of myogenic MEPs. Addition of propofol significantly reduced the ketamine-induced psychedelic effects.

Cited by 75 publications

References 33 publications

Intraoperative monitoring of motor evoked potentials in very young children

Intraoperative monitoring of motor evoked potentials in very young children

Electromyography and Instrumentation in Patients With Idiopathic Scoliosis

Noxious stimuli do not modify myogenic motor evoked potentials by electrical stimulation during anesthesia with propofol-based anesthesia

Contact Info

Product

Resources

About