Abstract
BackgroundBetter protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring.MethodsA total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded.ResultsSEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly.ConclusionsSEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients studied had normal neurological examination findings, hence, these results may not be applicable to patients with preexisting deficits.Trial registrationThe study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR2100045504 (18/04/2021).
Highlights
Better protection can be provided during neurosurgery due to the establishment of somatosensoryevoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies
SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 minimum alveolar concentration (MAC)
MEPs are highly sensitive to injury to the brain and spinal cord and are highly sensitive to changes in motor function, which can immediately reflect the influences of ischemia, traction and local operation on central nervous function [10, 11]
Summary
Better protection can be provided during neurosurgery due to the establishment of somatosensoryevoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. Clinical methods for monitoring the nervous system include the wake-up test, somatosensory-evoked. The wake-up test is recommended as the golden standard, and can directly reflect the function of the nervous system during surgery. This test usually takes considerable time during surgery and frequently leads to psychological disorders in patients. It cannot be used for continuous intraoperative monitoring and cannot detect suspicious nerve damage in time. Some authorities recommend that SEPs be monitored in combination with MEPs to ensure the functional integrity of somatosensory and motor conduction pathways. SEPs and MEPs can complement each other to make nervous system monitoring complete and more robust
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