DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170654

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

Betul Isik, Güldem Turan, Suheyla Abitagaoglu, Osman Ekinci, Asu Özgültekin

Abstract


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.  


Keywords


Desflurane, Motor evoked potential, Scoliosis, TIVA

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References


Gomez JA, Hresko MT, Glotbecker MP. Nonsurgical Management of Adolescent Idiopathic Scoliosis. J Am Acad Orthop Surg. 2016;24:555-64.

Chang SH, Park YG, Kim DH, Yoon SY. Monitoring of motor and somatosensory evoked potentials during spine surgery: intraoperative changes and postoperative outcomes. Ann Rehabil Med. 2016;40:470-80.

Lin BC, Chen IH. Modified transcranial electromagnetic motor evoked potential obtained with train-of-four monitor for scoliosis surgery. Acta Anaesthesiologica Sinica. 1998;36:199-206.

Macdonald DB, Al Zayed Z, Khoudeir I, Stigsby B. Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine. 2003;28:194-200.

Moen KY, Nachemson AL. Treatment of scoliosis: an historical perspective. Spine.1999;24:2570-5.

Pajewski TN, Arlet V, Phillips LH. Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon. Euro Spine Journal. 2007;16:115-29.

Lyon JCR, Lieberman JA, Grabovac MT, Hu S. Strategies for managing decreased motor evoked potential signals while distracting the spine during correction of scoliosis. J Neurosurg Anesthesiol. 2004;16:167-70.

Dawson EG, Sherman JE, Kanim LE, Nuwer MR. Spinal Cord Monitoring. Results of the scoliosis research society and the european spinal deformity society survey. Spine. 1991;16:361-4.

Macdonald DB, Al Zayed Z, Khoudeir I, Stigsby B. Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine. 2003;28:194-203.

Sloan TB, Toleikis JR, Toleikis SC, Koht A. Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3 % desflurane. J Clinic Monitor Compu. 2015;29:77-85.

Lo YL, Dan YF, Tan YE, Nurjannah S, Tan SB, Tan CT et al. Intraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens. J Neurosurgy Anesthesiol. 2006;18:211-4.

Burke D, Hicks RG. Surgical monitoring of motor pathways. J Clinic Neurophysiol. 1998;15:194-205.

Bernard JM, Péréon Y, Fayet G, Guihéneuc P. Effects of isoflurane and desflurane on neurogenic motor- and somatosensory-evoked potential monitoring for scoliosis surgery. Anesthesiol. 1996;8:1013-9.

Chong CT, Manninen P, Sivanaser V, Subramanyam R, Lu N. Direct comparison of the effect of desflurane and sevoflurane on intraoperative motor-evoked potentials monitoring. J Neurosurg Anesthesiol. 2014;26:306-12.

Lo YL, Dan YF, Tan YE, Fook-Chong S, Tan SB, Tan CT, Raman S. Intraoperative monitoring study of ipsilateral motor evoked potentials in scoliosis surgery. Euro Spine J. 2006;15:656-60.

Kopp Lugli A, Yost CS, Kindler CH. Anaesthetic mechanisms: update on the challenge of unravelling the mystery of anaesthesia. Eur J Anaesthesiol. 2009;26:807-20.

Son Y. Molecular mechanisms of general anesthesia. Korean J Anesthesiol. 2010;59:3-8.

Campagna JA, Miller KW, Forman SA. Mechanisms of actions of inhaled anesthetics. The New Eng J Med. 2003;348:2110-24.

Nathan N. Tabaraud F, Lacroix, F, Mouliès D, Viviand X, Lansade A et al. Infuence of propofol concentrations on multipulse transcranial motor evoked potentials. Br.J.Anaesth. 2003;91:493-7.

Sloan TB, Mongan P, Lyda C, Koht A. Lidocaine infusion adjunct to total intravenous anesthesia reduces the total dose of propofol during intraoperative neurophysiological monitoring. J Clinic Monito Compu. 2014;28:139-47.

Tobias JD, Goble TJ, Bates G., Anderson JT, Hoernschemeyer DG. Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescents. Paediatr Anaesth. 2008;18:1082-8.

Suvadeep S, Chakraborty J, Santra S, Mukherjee P, Das B. The effect of dexmedetomidine infusion on propofol requirement for maintenance of optimum depth of anaesthesia during elective spine surgery. Indian J Anaesth. 2013;57:358-63.

Scheufler KM, Zentner J. Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. J. Neurosurg. 2002;96:571-9.

Kawaguchi M, Inoue S, Kakimoto M, Kitaguchi K, Furuya H, Morimoto T et al. The effect of sevoflurane on myogenic motorevoked potentials induced by single and paired transcranial electrical stimulation of the motor cortex during nitrous oxide/ketamine/fentanyl anesthesia. J Neurosur Anesthesiol. 1998;10:131-6.

Lotto ML, Banoub M, Schubert A. Effects of anesthetic agents and physiologic changes on intraoperative motor evoked potentials. J Neurosurg Anesthesiol. 2004;16:32-42.

Meylaerts SA, De Haan P, Kalkman CJ Lips J, De Mol BA, Jacobs MJ. The influence of regional spinal cord hypothermia on trancranial myogenic motor evoked potential monitoring and the efficacy of spinal cord ischemia detection. J Thorac Cardiovasc Sur. 1999; 118:1038-45.

Haghighi SS, Keller BP, Oro JJ, et al. Motor-evoked potential changes during hypoxic hypoxia. Surgery Neurol. J. 1993; 39: 399-402.

Priori A, Berardelli A, Mercury B, Inghilleri M, Manfredi M. The effect of hyperventitalion on motor cortical inhibition in humans: a stduy of the electromyographic silent period evoked by transranial brain stimulation. Electroencephalogr Clin Neorophysol. 1995;97:69-72.

Stephen JP, Sullivan MR, Hicks RG, Burke DJ, Woodforth IJ, Crawford MR. Cotrel-Dubousset ınstrumention in children using simultaneous motor and somatosensory evoked potential monitoring. J Spine, 1994;19:1518-24.