caa a22 4500 605509743 CHVBK 20210128100642.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s10877-014-9571-9 doi (NATIONALLICENCE)springer-10.1007/s10877-014-9571-9 Intraoperative neurophysiological monitoring during spine surgery with total intravenous anesthesia or balanced anesthesia with 3% desflurane [Elektronische Daten] [Tod Sloan, J. Toleikis, Sandra Toleikis, Antoun Koht] Total intravenous anesthesia (TIVA) with propofol and opioids is frequently utilized for spinal surgery when somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (tcMEPs) are monitored. Many anesthesiologists would prefer to utilize low dose halogenated anesthetics (e.g. 1/2 MAC). We examined our recent experience using 3% desflurane or TIVA during spine surgery to determine the impact on propofol usage and on the evoked potential responses. After institutional review board approval we conducted a retrospective review of a 6month period for adult spine patients who were monitored with SSEPs and tcMEPs. Cases were included for the study if anesthesia was conducted with propofol-opioid TIVA or 3% desflurane supplemented with propofol or opioid infusions as needed. We evaluated the propofol infusion rate, cortical amplitudes of the SSEPs (median nerve, posterior tibial nerve), amplitudes and stimulation voltage for eliciting the tcMEPs (adductor pollicis brevis, tibialis anterior) and the amplitude variability of the SSEP and tcMEP responses as assessed by the average percentage trial to trial change. Of the 156 spine cases included in the study, 95 had TIVA with propofol-opioid (TIVA) and 61 had 3% expired desflurane (INHAL). Three INHAL cases were excluded because the desflurane was eliminated because of inadequate responses and 26 cases (16 TIVA and 10 INHAL) were excluded due to significant changes during monitoring. Propofol infusion rates in the INHAL group were reduced from the TIVA group (average 115-45μg/kg/min) (p<0.00001) with 21 cases where propofol was not used. No statistically significant differences in cortical SSEP or tcMEP amplitudes, tcMEP stimulation voltages nor in the average trial to trial amplitude variability were seen. The data from these cases indicates that 1/2 MAC (3%) desflurane can be used in conjunction with SSEP and tcMEP monitoring for some adult patients undergoing spine surgery. Further studies are needed to confirm the relative benefits versus negative effects of the use of desflurane and other halogenated agents for anesthesia during procedures on neurophysiological monitoring involving tcMEPs. Further studies are also needed to characterize which patients may or may not be candidates for supplementation such as those with neural dysfunction or who are opioid tolerant from chronic use. Springer Science+Business Media New York, 2014 Propofol nationallicence Desflurane nationallicence Total intravenous anesthesia nationallicence Somatosensory evoked potentials nationallicence Motor evoked potentials nationallicence Spinal surgery nationallicence Sloan Tod Department of Anesthesiology, Anschutz Office West (AO1), MS 8202, University of Colorado Denver School of Medicine, 12631 E 17th Avenue, 80045, Aurora, CO, USA aut Toleikis J. Department of Anesthesiology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA aut Toleikis Sandra Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA aut Koht Antoun Departments of Anesthesiology, Neurosurgery, and Neurology, Northwestern University, Chicago, IL, USA aut Journal of Clinical Monitoring and Computing Springer Netherlands 29/1(2015-02-01), 77-85 1387-1307 29:1<77 2015 29 10877 https://doi.org/10.1007/s10877-014-9571-9 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10877-014-9571-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sloan Tod Department of Anesthesiology, Anschutz Office West (AO1), MS 8202, University of Colorado Denver School of Medicine, 12631 E 17th Avenue, 80045, Aurora, CO, USA aut NATIONALLICENCE 700 1- Toleikis J. Department of Anesthesiology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA aut NATIONALLICENCE 700 1- Toleikis Sandra Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA aut NATIONALLICENCE 700 1- Koht Antoun Departments of Anesthesiology, Neurosurgery, and Neurology, Northwestern University, Chicago, IL, USA aut NATIONALLICENCE 773 0- Journal of Clinical Monitoring and Computing Springer Netherlands 29/1(2015-02-01), 77-85 1387-1307 29:1<77 2015 29 10877