An evaluation of anesthetic fade in motor evoked potential monitoring in spinal deformity surgeries

Autor: Ryo Ugawa, Tomoyuki Takigawa, Hiroko Shimomiya, Takuma Ohnishi, Yuri Kurokawa, Yoshiaki Oda, Yasuyuki Shiozaki, Haruo Misawa, Masato Tanaka, Toshifumi Ozaki
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: Journal of Orthopaedic Surgery and Research, Vol 13, Iss 1, Pp 1-6 (2018)
Druh dokumentu: article
ISSN: 1749-799X
DOI: 10.1186/s13018-018-0934-7
Popis: Abstract Background Intraoperative neuromonitoring using motor evoked potentials (MEP) satisfactorily detects motor tract integrity changes during spinal surgery. However, monitoring is affected by “anesthetic fade,” in which the stimulation threshold increases because the waveform amplitude decreases with the accumulation of propofol. Therefore, the purpose of this study was to clarify the effect of anesthetic fade on transcranial MEPs by investigating the time-dependent changes of amplitude during spinal deformity surgeries. Methods We retrospectively reviewed medical records of 142 spinal deformity patients (66 patients with idiopathic scoliosis, 28 with adult spinal deformities, 19 with neuromuscular scoliosis, 17 with syndromic scoliosis, and 12 with congenital scoliosis). The average age was 28 years (range, 5 to 81 years). MEPs were recorded bilaterally from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles during spinal deformity surgeries. The Wilcoxon signed-rank test was used to investigate the time-dependent changes of amplitude after propofol infusion to evaluate anesthetic fade effects. Results The average time to baseline from initial propofol infusion was 113 min (range, 45 to 182 min). In the ADM, the amplitude was 52% at 1 h after initial propofol infusion, 102% at 2 h, 105% at 3 h, 101% at 4 h, 86% at 5 h, and 81% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 16% at 5 h (P
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