The influence of regional spinal cord hypothermia on transcranial myogenic motor-evoked potential monitoring and the efficacy of spinal cord ischemia detection

Meylaerts, S.A.G.; Haan, Peter; Kalkman, Cor J.; Lips, Jeroen; Mol, Bas A.J.M. de; Jacobs, Michael J.

doi:10.1016/s0022-5223(99)70099-1

Cited by 42 publications

(31 citation statements)

References 28 publications

(28 reference statements)

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“…This applies to all disc cup EEG electrodes and most type i corkscrew electrodes and EEG needle electrodes (Table 1). EEG disc cup electrodes and corkscrew electrodes DELETIS and CAMARGO, 2001;HICKS et al, 1992;KOTHBAUER et al, 1997;MEYLAERTS et al, 1999;PECHSTEIN et al, 1996; VAN-DONGEN et al, 1999) are used for TES in almost all centres. Table 1 shows that the mean Vth of 56 V with large contact-surface electrodes is increased to 251 (+250%) for the corkscrew (type i) and single EEG needle electrodes and to 347 (+346%) for the EEG disc cup surface electrodes.…”

Section: Discussionmentioning

confidence: 99%

Influence of electrode impedance on threshold voltage for transcranial electrical stimulation in motor evoked potential monitoring

Journée

Polak

Kleuver

2004

Med. Biol. Eng. Comput.

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Motor potentials evoked by transcranial electrical stimulation (TES) are used for monitoring the motor pathways, with emphasis on the spinal cord and brainstem. The stimulus voltage threshold is the voltage below which no motor response can be elicited. It has frequently been used as a monitoring parameter. However, its value can be limited, because it is affected by the impedance of the stimulus electrode. For example, the voltage threshold can change owing to formation of oedema of the scalp. The relationship between the TES voltage threshold and the electrode impedance of different electrode types was studied and discussed in the context of neuromonitoring: 323 impedance and voltage threshold pairs were studied, and TES was performed with disc cup EEG electrodes (six), corkscrew electrodes (type I: seven, type II: eight), multiple EEG needle electrodes (16) and a large needle electrode Cz' (anode) together with a ground strip over the forehead (cathode) (286). The study found the voltage threshold to be strongly dependent on electrode impedance when the impedance was higher than 460 omega (correlation: R2=0.87; p < 0.001). Below 460 omega, which included 91% of the category with the largest electrode surfaces, 25% of the multiple EEG electrodes and 75% of type II corkscrew electrodes, no significant correlation (R2=0.0064; p=0.15) was found. It was concluded that the correlation between the TES voltage threshold and electrode impedance can be markedly reduced by using TES electrodes with large contact surfaces, resulting in limit values for these parameters. This also may improve the reliability of TES motor evoked potential monitoring.

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Section: Discussionmentioning

confidence: 99%

Influence of electrode impedance on threshold voltage for transcranial electrical stimulation in motor evoked potential monitoring

Journée

Polak

Kleuver

2004

Med. Biol. Eng. Comput.

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“…However, despite these temperature effects on tcMEPs, the duration in which to perceive the spinal cord ischemia in hypothermia was found not to differ, compared with the normothermic group. 26 We did not determine hypothermia in our cases during their temperature follow-ups performed with TOF. We have limited knowledge about the effects of hypoxia on the tcMEP responses in humans.…”

Section: Resultsmentioning

confidence: 89%

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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“…Hypothermia increases tolerance to spinal cord ischemia by reducing the metabolic rate [28], inhibiting glutamate and dopamine release [29,30], producing heat shock proteins [31], and by many other unknown mechanisms [32]. Spinal cord cooling can be attained by either systemic cooling [6] or direct local cooling [16]. A number of studies have demonstrated a beneficial effect of local cooling by intrathecal perfusion with cold solution [33].…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we developed a rabbit spinal cord ischemia model by occluding the lumbar arteries with snare devices. This selective occlusion of lumbar arteries has been used in pigs [16] but not in rabbits before. In this model, hemodynamic changes during ischemia are minimal because the blood flow in the aorta is intact.…”

mentioning

confidence: 99%

Selective Occlusion of Lumbar Arteries as a Spinal Cord Ischemia Model in Rabbits

Maeda

Mori²,

Shiraishi³

et al. 2003

Jpn.J.Physiol

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Paraplegia caused by ischemia-reperfusion injury of the spinal cord remains a devastating and unpredictable complication of thoracoabdominal aortic aneurysm repair [1,2]. Cross-clamping of the aorta during the repair reduces the arterial pressure distal to the clamping site, which causes spinal cord ischemia with resultant paraplegia, renal dysfunction, and colonic ischemia [3]. In addition, aortic occlusion increases arterial pressure proximal to the clamp. This hypertension results in increased cardiac afterload and elevated cerebrospinal fluid (CSF) pressure. The latter may worsen spinal cord ischemia by decreasing the perfusion pressure. Many interventions have been proposed to prevent the consequences of aortic occlusion, including distal aortic perfusion [4], CSF drainage [5], hypothermia [6], production of heat shock proteins by preconditioning procedures [7,8], and pharmacological agents such as oxygen-free radical scavengers [9], iron chelators [10], N-methyl-D-asparate (NMDA) receptor antagonists [11,12], opiate antagonists [13], and vasodilators [14]. A number of studies have reported beneficial effects of these interventions, but most of them remain controversial. One of the reasons for the controversy is that the mechanism(s) of spinal cord ischemia-induced paraplegia is not fully understood. As mentioned above, aortic occlusion causes not only a pressure drop in the feeding artery of the spinal cord but also causes an increase in CSF pressure. In order to clarify the mechanism and reduce the incidence of paraplegia, a simple model of spinal ischemia that reduces blood flow to the spinal cord without increasing CSF pressure nor decreasing distal arterial pressure should be used to analyze the effect of treatment.

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The influence of regional spinal cord hypothermia on transcranial myogenic motor-evoked potential monitoring and the efficacy of spinal cord ischemia detection

Cited by 42 publications

References 28 publications

Influence of electrode impedance on threshold voltage for transcranial electrical stimulation in motor evoked potential monitoring

Influence of electrode impedance on threshold voltage for transcranial electrical stimulation in motor evoked potential monitoring

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

Selective Occlusion of Lumbar Arteries as a Spinal Cord Ischemia Model in Rabbits

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