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CC-BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2017; 04(03): 159-166
DOI: 10.4103/jnacc-jnacc-10.17
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

Nathan P. Royan
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
,
Nancy Lu
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
,
Pirjo Manninen
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
,
Lakshmikumar Venkatraghavan
1   Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
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Publikationsdatum:
08. Mai 2018 (online)

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Abstract

Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (<0.5 minimum alveolar concentration [MAC]) was used in 85% BA cases. Intraoperative neuromonitoring changes occurred in 11.8% (18/152) of cases. There was no statistical difference in the incidence of monitoring changes between BA (78%) and TIVA (22%) groups (P = 0.197). Anaesthetic or surgical interventions were performed in 12 patients, with a resolution of changes in 50% (P = 0.455). All 5 patients with persistent MEP changes had worsening of existing neurological deficits postoperatively; 8 had transient MEP changes, and 2 experienced worsening of existing neurological deficits. Conclusions: We found that intraoperative neurophysiological monitoring can be performed with both BA (MAC <0.5) and TIVA in high-risk spinal surgery with no statistical difference in the incidence of intraoperative monitoring changes.

Keywords

Balanced anaesthesia - inhalational anaesthesia - intravenous anaesthesia - motor evoked potentials - somatosensory evoked potentials
 

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