Successful Intraoperative Spinal Cord Monitoring During Scoliosis Surgery Using a Total Intravenous Anesthetic Regimen Including Dexmedetomidine

Abstract

Intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is widely used. Because of the possible interference with the recording of evoked potentials by inhalational anesthetics, total intravenous anesthetic (TIVA) regimens have been advocated. TIVA regimens may be difficult to use in pediatric populations due to metabolic factors. We report on the results of multimodality IONM during 18 cases in which a TIVA regimen incorporating dexmedetomidine (Precedex, Hespira, Lake Forest, IL) was used. Monitoring techniques included sensory (SSEP) and motor evoked potentials (MEP), as well as pedicle screw stimulation. SSEPs were maintained within an acceptable range of baseline amplitude (50%) and latency (10%), and MEPs remained elicitable throughout each case. We therefore found that the anesthetic regimen did not significantly interfere with any of the monitoring modalities used and conclude that IONM in the presence of dexmedetomidine is feasible under appropriate conditions.

Transcranial motor evoked potentials during anesthesia with desflurane versus propofol – A prospective randomized trial

“…Similarly, we defined equipotential doses of propofol and desflurane in combination with remifentanil based on an intraindividual nearly constant BIS range. Although other protocols in the literature used BISguided comparisons (Nathan et al, 2003;Liu et al, 2005;Anschel et al, 2008), whether this approach is accurate enough to predict comparable depth of anesthesia is still not completely clear. Thus, we cannot exclude relevant differences in hypnotic levels provided by BIS-guided anesthesia protocols in both of our groups.…”

Effects of different etomidate doses on intraoperative somatosensory-evoked potential monitoring

“…Considering the possible dose-related adrenal cortical depressive effects, we believe that increasing the etomidate dose to achieve better amplification of SSEPs is impractical. Thus, in order to optimize the anesthesia plan for difficult cases, other medications, such as a 2 receptor agonists [18,19] or NMDA receptor antagonists [20,21], can be applied as auxiliary treatments. By reducing the amounts of remifentanil and propofol, the inhibition effects might be attenuated.…”

Recomendaciones –guía– en la lesión aguda medular intraoperatoria en cirugía correctora del raquis

“…remifentanilo 0,3-1 μg kg -1 min -1 con bajas dosis de propofol y nula o mínima utilización de N 2 O y/o agentes halogenados (< 1 CAM: concentración alveolar mínima). La dexmedetomidina puede utilizarse como adyuvante de la anestesia sin que afecte a la MNI [39][40][41] . Para un registro eficaz de los PEM por estimulación transcraneal, hay que minimizar el empleo de bloqueantes neuromusculares (BNM) o bien realizar su titulación apropiada mediante perfusión continua y monitorización del grado de bloqueo neuromuscular en nervio periférico, permitiendo como mínimo dos respuestas en la secuencia de cuatro estímulos (TOF: "train of four").…”