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Journal of Clinical Monitoring and Computing

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01-06-2019 | Original Research

Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia

Authors: Hai-yan Liu, Tian-jiao Xia, Ze-zhang Zhu, Xing Zhao, Yue Qian, Zheng-liang Ma, Xiao-ping Gu

Published in: Journal of Clinical Monitoring and Computing | Issue 3/2019

Abstract

Transcranial electric motor evoked potentials (TCeMEPs) play an important role in reducing the risk of iatrogenic paraplegia. TCeMEPs could be obviously suppressed by neuromuscular blockade (NMB). The aims of this study were to examine the effects of NMB on TCeMEPs and to determine an appropriate level of partial neuromuscular blockade (pNMB) for TCeMEPs during surgical correction of idiopathic scoliosis under total intravenous anesthesia (TIVA). All patients were maintained with TIVA. The pNMB levels were classified into five phases: one or two train-of-four (TOF) counts (TOF₁); three TOF counts, or T₄/T₁ (TOFR, T_1,4, first or four twitch height of TOF) ≤ 15% (TOF₂); TOFR at 16–25% (TOF₃); TOFR at 26–50% (TOF₄); and TOFR at 51–75% (TOF₅). No neuromuscular blockade (nNMB) was achieved when TOFR was more than 75%. The absolute and relative latency, amplitude and area under curve (AUC), efficacy of TCeMEPs and rate of unexpected movement were compared among these phases. Neither the amplitude and AUC nor the efficacy of TCeMEPs were affected at TOF₄₋₅ of abductor halluces muscles TCeMEPs (AH-TCeMEPs) or at TOF₃₋₅ of tibialis anterior muscles TCeMEPs (TA-TCeMEPs) compared with nNMB. However, the rate of unexpected movement was increased significantly at TOF₅ and nNMB compared with TOF₁ and TOF₄. The application of pNMB with TOFR aimed at 26–50% for AH-TCeMEPs or 16–50% for TA-TCeMEPs seems to be an appropriate regimen for TCeMEPs during surgical correction for idiopathic scoliosis under TIVA.

Vitale MG, Moore DW, Matsumoto H, Emerson RG, Booker WA, Gomez JA, Gallo EJ, Hyman JE, Roye DP Jr. Risk factors for spinal cord injury during surgery for spinal deformity. J Bone Joint Surg. 2010;92(1):64–71. https://doi.org/10.2106/jbjs.h.01839.CrossRefPubMed

Neira VM, Ghaffari K, Bulusu S, Moroz PJ, Jarvis JG, Barrowman N, Splinter W. Diagnostic accuracy of neuromonitoring for identification of new neurologic deficits in pediatric spinal fusion surgery. Anesth Analg. 2016;123(6):1556–66. https://doi.org/10.1213/ane.0000000000001503.CrossRefPubMed

Pastorelli F, Di Silvestre M, Plasmati R, Michelucci R, Greggi T, Morigi A, Bacchin MR, Bonarelli S, Cioni A, Vommaro F, Fini N, Lolli F, Parisini P. The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. Eur Spine J. 2011;20(Suppl 1):105–14. https://doi.org/10.1007/s00586-011-1756-z.CrossRefPubMedCentral

Thuet ED, Winscher JC, Padberg AM, Bridwell KH, Lenke LG, Dobbs MB, Schootman M, Luhmann SJ. Validity and reliability of intraoperative monitoring in pediatric spinal deformity surgery: a 23-year experience of 3436 surgical cases. Spine. 2010;35(20):1880–6. https://doi.org/10.1097/BRS.0b013e3181e53434.CrossRefPubMed

Ohtaki S, Akiyama Y, Kanno A, Noshiro S, Hayase T, Yamakage M, Mikuni N. The influence of depth of anesthesia on motor evoked potential response during awake craniotomy. J Neurosurg. 2017;126(1):260–5. https://doi.org/10.3171/2015.11.jns151291.CrossRefPubMed

Lieberman JA, Feiner J, Lyon R, Rollins MD. Effect of hemorrhage and hypotension on transcranial motor-evoked potentials in swine. Anesthesiology. 2013;119(5):1109–19. https://doi.org/10.1097/ALN.0b013e31829d4a92.CrossRefPubMed

Sakamoto T, Kawaguchi M, Kakimoto M, Inoue S, Takahashi M, Furuya H. The effect of hypothermia on myogenic motor-evoked potentials to electrical stimulation with a single pulse and a train of pulses under propofol/ketamine/fentanyl anesthesia in rabbits. Anesth Analg. 2003;96(6):1692–7 (table of contents).CrossRefPubMed

Sloan TB, Heyer EJ. Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol. 2002;19(5):430–43.CrossRefPubMed

Tsutsui S, Iwasaki H, Yamada H, Hashizume H, Minamide A, Nakagawa Y, Nishi H, Yoshida M. Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery. J Clin Monit Comput. 2015;29(1):35–9. https://doi.org/10.1007/s10877-014-9565-7.CrossRefPubMed

10.

Yang J, Huang Z, Shu H, Chen Y, Sun X, Liu W, Dou Y, Xie C, Lin X, Hu Y. Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children. Eur Spine J. 2012;21(5):980–4. https://doi.org/10.1007/s00586-011-1995-z.CrossRefPubMed

11.

Azabou E, Manel V, Andre-obadia N, Fischer C, Mauguiere F, Peiffer C, Lofaso F, Shils JL. Optimal parameters of transcranial electrical stimulation for intraoperative monitoring of motor evoked potentials of the tibialis anterior muscle during pediatric scoliosis surgery. Clin Neurophysiol. 2013;43(4):243–50. https://doi.org/10.1016/j.neucli.2013.08.001.CrossRef

12.

Mendiratta A, Emerson RG. Neurophysiologic intraoperative monitoring of scoliosis surgery. J Clin Neurophysiol. 2009;26(2):62–9. https://doi.org/10.1097/WNP.0b013e31819f9049.CrossRefPubMed

13.

Kalkman CJ, Drummond JC, Kennelly NA, Patel PM, Partridge BL. Intraoperative monitoring of tibialis anterior muscle motor evoked responses to transcranial electrical stimulation during partial neuromuscular blockade. Anesth Analg. 1992;75(4):584–9.CrossRefPubMed

14.

van Dongen EP, ter Beek HT, Schepens MA, Morshuis WJ, Langemeijer HJ, de Boer A, Boezeman EH. Within-patient variability of myogenic motor-evoked potentials to multipulse transcranial electrical stimulation during two levels of partial neuromuscular blockade in aortic surgery. Anesth Analg. 1999;88(1):22–7.PubMed

15.

Cengiz M, Ganidagli S, Alatas N, San I, Baysal Z. Partial neuromuscular blockage levels with mivacurium during mastoidectomy allows intraoperative facial nerve monitoring. ORL. 2008;70(4):236–241. https://doi.org/10.1159/000130871.CrossRefPubMed

16.

Claudius C, Viby-Mogensen J. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence. Anesthesiology. 2008;108(6):1117–40. https://doi.org/10.1097/ALN.0b013e318173f62f.CrossRefPubMed

17.

Leon-Sarmiento FE, Rizzo-Sierra CV, Leon-Ariza JS, Leon-Ariza DS, Sobota R, Prada DG. A new neurometric dissection of the area-under-curve-associated jiggle of the motor evoked potential induced by transcranial magnetic stimulation. Physiol Behav. 2015;141:111–9. https://doi.org/10.1016/j.physbeh.2015.01.014.CrossRefPubMed

18.

Tamkus AA, Rice KS, Kim HL. Differential rates of false-positive findings in transcranial electric motor evoked potential monitoring when using inhalational anesthesia versus total intravenous anesthesia during spine surgeries. Spine J. 2014;14(8):1440–6. https://doi.org/10.1016/j.spinee.2013.08.037.CrossRefPubMed

19.

Zhuang Q, Wang S, Zhang J, Zhao H, Wang Y, Tian Y, Zhao Y, Li S, Weng X, Qiu G, Shen J. How to make the best use of intraoperative motor evoked potential monitoring? Experience in 1162 consecutive spinal deformity surgical procedures. Spine. 2014;39(24):E1425–32. https://doi.org/10.1097/brs.0000000000000589.CrossRefPubMed

20.

Sloan TB, Erian R. Effect of vecuronium-induced neuromuscular blockade on cortical motor evoked potentials. Anesthesiology. 1993;78(5):966–73.CrossRefPubMed

21.

Kim WH, Lee JJ, Lee SM, Park MN, Park SK, Seo DW, Chung IS. Comparison of motor-evoked potentials monitoring in response to transcranial electrical stimulation in subjects undergoing neurosurgery with partial vs no neuromuscular block. Br J Anaesth. 2013;110(4):567–76. https://doi.org/10.1093/bja/aes395.CrossRefPubMed

22.

Hemmer LB, Zeeni C, Bebawy JF, Bendok BR, Cotton MA, Shah NB, Gupta DK, Koht A. The incidence of unacceptable movement with motor evoked potentials during craniotomy for aneurysm clipping. World Neurosurg. 2014;81(1):99–104. https://doi.org/10.1016/j.wneu.2012.05.034.CrossRefPubMed

23.

Yamamoto Y, Kawaguchi M, Hayashi H, Horiuchi T, Inoue S, Nakase H, Sakaki T, Furuya H. The effects of the neuromuscular blockade levels on amplitudes of posttetanic motor-evoked potentials and movement in response to transcranial stimulation in patients receiving propofol and fentanyl anesthesia. Anesth Analg. 2008;106(3):930–4. https://doi.org/10.1213/ane.0b013e3181617508 (table of contents).CrossRefPubMed

24.

Mahmoud M, Sadhasivam S, Salisbury S, Nick TG, Schnell B, Sestokas AK, Wiggins C, Samuels P, Kabalin T, McAuliffe J. Susceptibility of transcranial electric motor-evoked potentials to varying targeted blood levels of dexmedetomidine during spine surgery. Anesthesiology. 2010;112(6):1364–73. https://doi.org/10.1097/ALN.0b013e3181d74f55.CrossRefPubMed

25.

Schwartz DM, Sestokas AK, Dormans JP, Vaccaro AR, Hilibrand AS, Flynn JM, Li PM, Shah SA, Welch W, Drummond DS, Albert TJ. Transcranial electric motor evoked potential monitoring during spine surgery: is it safe? Spine. 2011;36(13):1046–9. https://doi.org/10.1097/BRS.0b013e3181ecbe77.CrossRefPubMed

26.

Oro J, Haghighi SS. Effects of altering core body temperature on somatosensory and motor evoked potentials in rats. Spine. 1992;17(5):498–503.CrossRefPubMed

27.

Schwartz DM, Auerbach JD, Dormans JP, Flynn J, Drummond DS, Bowe JA, Laufer S, Shah SA, Bowen JR, Pizzutillo PD, Jones KJ, Drummond DS. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg. 2007;89(11):2440–9. https://doi.org/10.2106/jbjs.f.01476.CrossRefPubMed

Title: Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia
Authors: Hai-yan Liu
Tian-jiao Xia
Ze-zhang Zhu
Xing Zhao
Yue Qian
Zheng-liang Ma
Xiao-ping Gu
Publication date: 01-06-2019
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 3/2019
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-018-0182-8

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Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia

Abstract

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Abstract

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