The effects of isoflurane and propofol on intraoperative neurophysiological monitoring during spinal surgery

被引:71
作者
Chen Z. [1 ]
机构
[1] Active Diagnostics Inc., Davis, CA 95616
关键词
Electromyographic activity; Evoked potentials; Intraoperative monitoring; Isoflurane; Propofol;
D O I
10.1007/s10877-005-5097-5
中图分类号
学科分类号
摘要
Objectives: To compare the effects of isoflurane and propofol on intraoperative neurophysiological monitoring (IONM) during spinal surgery. Methods. Thirty-five patients were randomly assigned to receive isoflurane (n = 17) or propofol (n = 18) anesthesia. Somatosensory evoked potentials (SEPs) following posterior tibial nerve stimulation were recorded before induction as baselines. Isoflurane concentrations and propofol infusions were adjusted to obtain four pre-determined BIS ranges: 65-55, 55-45, 45-35 and 35-25. For each range, a stable state was maintained for at least 10 min to perform IONM. The SEP latency P40 and amplitude P40-N50, the onset latency and amplitude of transcranial motor evoked potentials (tcMEPs), and threshold intensity of triggered electromyographic activity (EMG) following pedicle screw stimulation were statistically analyzed. Results. Compared with baseline values, P40 latency increased and P40-N50 amplitude decreased after anesthesia with isoflurane or propofol. Isoflurane caused a dose-dependent depression of SEPs, but propofol did not. TcMEPs were recordable and stable in all patients receiving propofol in each BIS range, but only recordable in 10 (58.8%) receiving isoflurane with BIS > 55, and 3 (17.8%) with BIS < 55. No difference was noted in triggered EMG. Conclusions. Isoflurane inhibited IONM more than propofol. Propofol is recommended for critical spinal surgery, particularly when motor pathway function is monitored. © Springer Science + Business Media, Inc. 2005.
引用
收藏
页码:303 / 308
页数:5
相关论文
共 21 条
[1]  
Calancie B., Harris W., Broron J.G., Alexeeva M., Green B.A., Threshold-level multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: Description of method and compression to somatosensory evoked potential monitoring, Neurosurgery, 88, pp. 457-470, (1998)
[2]  
Holland N.R., Spine update: Intraoperative electromyography during thoracolumbar spinal surgery, Spine, 23, 17, pp. 1915-1922, (1998)
[3]  
Lenke L.G., Padberg A.M., Russo M.H., Bridwell K.H., Gelb D.E., Triggered electromyographic threshold for accuracy of pedicle screw placement: An animal model and clinical correlation, Spine, 20, 4, pp. 1585-1591, (1995)
[4]  
Maurette P., Simeon F., Castagnera L., Esposito J., Macouillard G., Heraut L.A., Propofol anesthesia alters somatosensory evoked potentials, Anesthesia, 43, pp. 44-45, (1988)
[5]  
Padberg A.M., Bridwell K.H., Spinal cord monitoring. Current state of the art, Orthop. Clin. North Am., 30, pp. 407-433, (1999)
[6]  
Slimp J.C., Electrophysiologic intraoperative monitoring for spine procedures, Phys. Med. Rehabil. Clin. N. Am. (United States), 15, 1, pp. 85-105, (2004)
[7]  
Boisseau N., Madany M., Staccini P., Armando G., Martin F., Grimaud D., Raucoules-Aime M., Comparison of the effect of sevoflurane and propofol on cortical somatosensory evoked potentials, Br. J. Anaesth., 88, 6, pp. 785-789, (2002)
[8]  
Ku A.S., Hu Y., Irwin M.G., Chow B., Gunawardene S., Tan E.E., Luk K.D., Effect of sevoflurane/nitrous oxide versus propofol anesthesia on somatosensory evoked potential monitoring of the spinal cord during surgery to correct scoliosis, Br. J. Anesth., 88, 4, pp. 502-507, (2002)
[9]  
Kumar A., Bhattacharyaa A., Makhija N., Evoked potential monitoring in anesthesia and analgesia, Anesthesia, 55, pp. 225-241, (2000)
[10]  
Taniguchi M., Nadstawek J., Pechstein U., Schramm J., Total intravenous anesthesia for improvement of intraoperative monitoring of somatosensory evoked potentials during aneurysm surgery, Neurosurgery, 31, 5, pp. 891-897, (1992)