Abstract
BackgroundIntraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen.ResultsIntraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient.ConclusionsBoth dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.
Highlights
Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery
We used propofol-based total intravenous anesthesia (TIVA) with either dexmedetomidine or fentanyl as adjuvants to minimize the use of inhalational agents which are known to interfere with neurophysiological monitoring
Our study was of a smaller sample size as our institute is not a spine specialty center, and the number of pediatric patients coming for kyphoscoliosis correction surgery in which Somatosensory-evoked potential (SSEP) can be utilized is limited
Summary
Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. We used propofol-based total intravenous anesthesia (TIVA) with either dexmedetomidine or fentanyl as adjuvants to minimize the use of inhalational agents which are known to interfere with neurophysiological monitoring. Fentanyl is a synthetic opioid of the phenylpiperidine family and is structurally related to meperidine (Lalonde, 2015) It is highly potent with a rapid onset and a shorter duration of action. Higher doses of fentanyl, used to administer anesthesia, are proven effective and safe for use in kyphoscoliosis correction surgeries
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