The Association of Physiological and Pharmacological Anesthetic Parameters With Motor-Evoked Potentials: A Multivariable Longitudinal Mixed Model Analysis.
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
28 Dec 2023
28 Dec 2023
Historique:
medline:
28
12
2023
pubmed:
28
12
2023
entrez:
28
12
2023
Statut:
aheadofprint
Résumé
During spinal surgery, the motor tracts can be monitored using muscle-recorded transcranial electrical stimulation motor-evoked potentials (mTc-MEPs). We aimed to investigate the association of anesthetic and physiological parameters with mTc-MEPs. Intraoperative mTc-MEP amplitudes, mTc-MEP area under the curves (AUC), and anesthetic and physiological measurements were collected retrospectively from the records of 108 consecutive patients undergoing elective spinal surgery. Pharmacological parameters of interest included propofol and opioid concentration, ketamine and noradrenaline infusion rates. Physiological parameters recorded included mean arterial pressure (MAP), bispectral index (BIS), heart rate, hemoglobin O2 saturation, temperature, and Etco2. A forward selection procedure was performed using multivariable mixed model analysis. Data from 75 (69.4%) patients were included. MAP and BIS were significantly associated with mTc-MEP amplitude (P < .001). mTc-MEP amplitudes increased by 6.6% (95% confidence interval [CI], 2.7%-10.4%) per 10 mm Hg increase in MAP and by 2.79% (CI, 2.26%-3.32%) for every unit increase in BIS. MAP (P < .001), BIS (P < .001), heart rate (P = .01), and temperature (P = .02) were significantly associated with mTc-MEP AUC. The AUC increased by 7.5% (CI, 3.3%-11.7%) per 10 mm Hg increase of MAP, by 2.98% (CI, 2.41%-3.54%) per unit increase in BIS, and by 0.68% (CI, 0.13%-1.23%) per beat per minute increase in heart rate. mTc-MEP AUC decreased by 21.4% (CI, -38.11% to -3.98%) per degree increase in temperature. MAP, BIS, heart rate, and temperature were significantly associated with mTc-MEP amplitude and/or AUC. Maintenance of BIS and MAP at the high normal values may attenuate anesthetic effects on mTc-MEPs.
Sections du résumé
BACKGROUND
BACKGROUND
During spinal surgery, the motor tracts can be monitored using muscle-recorded transcranial electrical stimulation motor-evoked potentials (mTc-MEPs). We aimed to investigate the association of anesthetic and physiological parameters with mTc-MEPs.
METHODS
METHODS
Intraoperative mTc-MEP amplitudes, mTc-MEP area under the curves (AUC), and anesthetic and physiological measurements were collected retrospectively from the records of 108 consecutive patients undergoing elective spinal surgery. Pharmacological parameters of interest included propofol and opioid concentration, ketamine and noradrenaline infusion rates. Physiological parameters recorded included mean arterial pressure (MAP), bispectral index (BIS), heart rate, hemoglobin O2 saturation, temperature, and Etco2. A forward selection procedure was performed using multivariable mixed model analysis.
RESULTS
RESULTS
Data from 75 (69.4%) patients were included. MAP and BIS were significantly associated with mTc-MEP amplitude (P < .001). mTc-MEP amplitudes increased by 6.6% (95% confidence interval [CI], 2.7%-10.4%) per 10 mm Hg increase in MAP and by 2.79% (CI, 2.26%-3.32%) for every unit increase in BIS. MAP (P < .001), BIS (P < .001), heart rate (P = .01), and temperature (P = .02) were significantly associated with mTc-MEP AUC. The AUC increased by 7.5% (CI, 3.3%-11.7%) per 10 mm Hg increase of MAP, by 2.98% (CI, 2.41%-3.54%) per unit increase in BIS, and by 0.68% (CI, 0.13%-1.23%) per beat per minute increase in heart rate. mTc-MEP AUC decreased by 21.4% (CI, -38.11% to -3.98%) per degree increase in temperature.
CONCLUSIONS
CONCLUSIONS
MAP, BIS, heart rate, and temperature were significantly associated with mTc-MEP amplitude and/or AUC. Maintenance of BIS and MAP at the high normal values may attenuate anesthetic effects on mTc-MEPs.
Identifiants
pubmed: 38153871
doi: 10.1213/ANE.0000000000006757
pii: 00000539-990000000-00688
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.
Déclaration de conflit d'intérêts
Conflicts of Interest: See Disclosures at the end of the article.
Références
Fehlings MG, Brodke DS, Norvell DC, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine (Phila Pa 1976). 2010;35:S37–S46.
MacDonald DB, Skinner S, Shils J, Yingling C; American Society of Neurophysiological Monitoring. Intraoperative motor evoked potential monitoring—a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol. 2013;124:2291–2316.
Macdonald DB. Overview on criteria for MEP monitoring. J Clin Neurophysiol. 2017;34:4–11.
Langeloo DD, Journée HL, de Kleuver M, Grotenhuis JA. Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery. A review and discussion of the literature. Clin Neurophysiol. 2007;37:431–439.
Hausmann ON, Min K, Boos N, Ruetsch YA, Erni T, Curt A. Transcranial electrical stimulation: significance of fast versus slow charge delivery for intra-operative monitoring. Clin Neurophysiol. 2002;113:1532–1535.
Journée HL, Berends HI, Kruyt MC. The percentage of amplitude decrease warning criteria for transcranial MEP monitoring. J Clin Neurophysiol. 2017;34:22–31.
Langeloo D-D, Journée H-L, Kleuver M de, Grotenhuis JA. Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery. Clin Neurophysiol. 2007;37:431–439.
Dulfer SE, Drost G, Lange F, Journee HL, Wapstra FH, Hoving EW. Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery. Child’s Nervous System. 2017;33:1985–1995.
Sala F, Palandri G, Basso E, et al. Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006;58:1129–1143.
Carson RG, Nelson BD, Buick AR, Carroll TJ, Kennedy NC, Cann R. Characterizing changes in the excitability of corticospinal projections to proximal muscles of the upper limb. Brain Stimul. 2013;6:760–768.
Yoshida G, Ando M, Imagama S, et al. Alert timing and corresponding intervention with intraoperative spinal cord monitoring for high-risk spinal surgery. Spine (Phila Pa 1976). 2019;44:E470–E479.
Langeloo DD, Lelivelt A, Journée HL, Slappendel R, Kleuver M de. Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine. 2003;28:1043–1050.
Kothbauer KF. Motor evoked potential monitoring for intramedullary spinal cord tumor surgery. In: Deletis V, Shills JL, eds. Neurophysiology in Neurosurgery. A Modern Intraoperative Approach. Academic Press, 2002:73–92.
Sahinovic MM, Gadella MC, Shils J, Dulfer SE, Drost G. Anesthesia and intraoperative neurophysiological spinal cord monitoring. Curr Opin Anaesthesiol. 2021;34:590–596.
Admiraal M, Hermanns H, Hermanides J, et al. Study protocol for the TRUSt trial: a pragmatic randomised controlled trial comparing the standard of care with a transitional pain service for patients at risk of chronic postsurgical pain undergoing surgery. BMJ Open. 2021;11.
Twisk JWR. Applied Multilevel Analysis: A Practical Guide for Medical Researchers (Practical Guides to Biostatistics and Epidemiology). Cambridge University Press, 2006;196.
Dulfer SE, Sahinovic MM, Lange F, et al. The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol. J Clin Monit Comput. 2021;35:967–977.
Meng L, Hou W, Chui J, Han R, Gelb AW. Cardiac output and cerebral blood flow the integrated regulation of brain perfusion in adult humans. Anesthesiology. 2015;123:1198–1208.
Cordella R, Orena E, Acerbi F, et al. Motor evoked potentials and bispectral index-guided anaesthesia in image-guided mini-invasive neurosurgery of supratentorial tumors nearby the cortico-spinal tract. Turk Neurosurg. 2018;28:341–348.
Nathan N, Tabaraud F, Lacroix F, et al. Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth. 2003;91:493–497.
Hurrie DMG, Talebian Nia M, Power K, et al. Spinal and corticospinal excitability in response to reductions in skin and core temperatures via whole-body cooling. Appl Physiol Nutr Metab. 2022;47:195–205.
Macdonald DB. Intraoperative motor evoked potential monitoring: overview and update. J Clin Monit Comput. 2006;20:347–377.
Lyon R, John F, Lieberman J. Progressive enhancement of motor-evoked potentials during general anesthesia: the phenomenon of “anesthetic fade-in.”. J Neurosurg Anesthesiol. 2013;25:87–89.
Andleeb R, Agrawal S, Gupta P. Evaluation of the effect of continuous infusion of dexmedetomidine or a subanesthetic dose ketamine on transcranial electrical motor evoked potentials in adult patients undergoing elective spine surgery under total intravenous anesthesia: a randomized controlled exploratory study. Asian Spine J. 2021;16:221–230.
Ziemann U. TMS and drugs. Clin Neurophysiol. 2004;115:1717–1729.
Rekling JC, Funk GD, Bayliss DA, Dong XW, Feldman JL. Synaptic control of motoneuronal excitability. Physiol Rev. 2000;80:767–852.
Skinner S, Sala F. Communication and collaboration in spine neuromonitoring: time to expect more, a lot more, from the neurophysiologists. J Neurosurg Spine. 2017;27:1–6.