J Clin Monit Comput - Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3% desflurane.

Tópicos

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Resumo

Total intravenous anesthesia (TIVA) with propofol and opioids is frequently utilized for spinal surgery when somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (tcMEPs) are monitored. Many anesthesiologists would prefer to utilize low dose halogenated anesthetics (e.g. 1/2 MAC). We examined our recent experience using 3% desflurane or TIVA during spine surgery to determine the impact on propofol usage and on the evoked potential responses. After institutional review board approval we conducted a retrospective review of a 6 month period for adult spine patients who were monitored with SSEPs and tcMEPs. Cases were included for the study if anesthesia was conducted with propofol-opioid TIVA or 3% desflurane supplemented with propofol or opioid infusions as needed. We evaluated the propofol infusion rate, cortical amplitudes of the SSEPs (median nerve, posterior tibial nerve), amplitudes and stimulation voltage for eliciting the tcMEPs (adductor pollicis brevis, tibialis anterior) and the amplitude variability of the SSEP and tcMEP responses as assessed by the average percentage trial to trial change. Of the 156 spine cases included in the study, 95 had TIVA with propofol-opioid (TIVA) and 61 had 3% expired desflurane (INHAL). Three INHAL cases were excluded because the desflurane was eliminated because of inadequate responses and 26 cases (16 TIVA and 10 INHAL) were excluded due to significant changes during monitoring. Propofol infusion rates in the INHAL group were reduced from the TIVA group (average 115-45 ?g/kg/min) (p<0.00001) with 21 cases where propofol was not used. No statistically significant differences in cortical SSEP or tcMEP amplitudes, tcMEP stimulation voltages nor in the average trial to trial amplitude variability were seen. The data from these cases indicates that 1/2 MAC (3%) desflurane can be used in conjunction with SSEP and tcMEP monitoring for some adult patients undergoing spine surgery. Further studies are needed to confirm the relative benefits versus negative effects of the use of desflurane and other halogenated agents for anesthesia during procedures on neurophysiological monitoring involving tcMEPs. Further studies are also needed to characterize which patients may or may not be candidates for supplementation such as those with neural dysfunction or who are opioid tolerant from chronic use.

Resumo Limpo

total intraven anesthesia tiva propofol opioid frequent util spinal surgeri somatosensori evok potenti ssep transcrani motor evok potenti tcmep monitor mani anesthesiologist prefer util low dose halogen anesthet eg mac examin recent experi use desfluran tiva spine surgeri determin impact propofol usag evok potenti respons institut review board approv conduct retrospect review month period adult spine patient monitor ssep tcmep case includ studi anesthesia conduct propofolopioid tiva desfluran supplement propofol opioid infus need evalu propofol infus rate cortic amplitud ssep median nerv posterior tibial nerv amplitud stimul voltag elicit tcmep adductor pollici brevi tibiali anterior amplitud variabl ssep tcmep respons assess averag percentag trial trial chang spine case includ studi tiva propofolopioid tiva expir desfluran inhal three inhal case exclud desfluran elimin inadequ respons case tiva inhal exclud due signific chang monitor propofol infus rate inhal group reduc tiva group averag gkgmin p case propofol use statist signific differ cortic ssep tcmep amplitud tcmep stimul voltag averag trial trial amplitud variabl seen data case indic mac desfluran can use conjunct ssep tcmep monitor adult patient undergo spine surgeri studi need confirm relat benefit versus negat effect use desfluran halogen agent anesthesia procedur neurophysiolog monitor involv tcmep studi also need character patient may may candid supplement neural dysfunct opioid toler chronic use

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