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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 587-596
DOI: 10.1055/s-0043-1772762
Original Article

Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Sharmishtha Pathak
1   Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
,
Priyanka Gupta 
2   Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Ashutosh Kaushal
3   Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Konish Biswas
4   Department of Neuroanaesthesiology and Critical Care, Medanta, Patna, Bihar, India
› Author Affiliations
Funding None.
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Abstract

Objectives Total intravenous anesthesia (TIVA) is used during surgery with intraoperative neurophysiological monitoring. Addition of adjuvant may minimize suppression of potentials by reducing doses of propofol. We studied the effect of addition of ketamine or dexmedetomidine to propofol–fentanyl-based TIVA on corticobulbar motor evoked potential (CoMEP) in patients undergoing posterior fossa surgeries.

Materials and Methods Forty-two patients were assigned to three groups (n = 14 each), Group S—saline, Group D—dexmedetomidine (0.25 μg/kg/h), and Group K—ketamine (0.25 mg/kg/h). Patients received propofol and fentanyl infusions along with study drugs. CoMEPs were recorded from muscles innervated by cranial nerves bilaterally at predefined intervals (Tbaseline, T2, T3, T4, and T5). Effect on amplitude and latency of CoMEPs was assessed.

Results A significant fall in CoMEP amplitude was observed across all analyzed muscles at time T4 and T5 in saline and dexmedetomidine group as compared with ketamine group, p-value less than 0.05. A significant increase in latency was observed at T4 and T5 among groups (p-value, D vs. K = 0.239, D vs. S = 0.123, and K vs. S = 0.001).

Conclusion Both ketamine and dexmedetomidine provide and allow effective recording of CoMEPs. Ketamine emerges as a better agent especially when prolonged surgical duration is expected as even propofol–fentanyl-based TIVA adversely affects CoMEPs when used for long duration.

Keyword Dexmedetomidine

intraoperative neurophysiological monitoring - motor evoked potential - MEP amplitude - MEP - latency ketamine

Ethical Approval

This study was approved by the university's ethical review committee under the ID: ECR/736/Inst/UK/2015/RR-18, 09/08/2019. The Clinical Trials Registry India ID is CTRI/2019/08/020817


Note

This paper was presented orally at SNACC-2021 (Virtual mode). The study confirms to the Declaration of Helsinki .


Authors’ contribution

S.P. and P.G. have given substantial contributions to the conception and the design of the manuscript. S.P. has worked toward acquisition, analysis and interpretation of the data. All authors have participated to drafting the manuscript, P.G. revised it critically. A.K. and K.B. have provided critical input to the drafting of manuscript. All the authors have read and approved the final version of the manuscript.




Publication History

Article published online:
13 September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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