Comparison of Isoflurane Effects on Motor Evoked Potential and F Wave
Comparison of Isoflurane Effects on Motor Evoked Potential and F Wave
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异氟醚对运动诱发电位和F波影响的比较
DOI：
10.1097/00000542-200007000-00010
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发表时间：
2000
期刊：
影响因子：
8.8
通讯作者：
Ching Zhu
中科院分区：
文献类型：
--
作者：
Henry H. Zhou;Ching Zhu
背景：挥发性麻醉剂通过抑制运动系统产生手术不动。运动通路中的麻醉作用部位尚不清楚。通过测量运动诱发电位（MEP）和F波来研究麻醉对整个和下部运动通路的影响。本研究测量了异氟醚对MEP和F波的影响。方法经机构审查委员会批准，我们研究了12例美国麻醉医师学会身体状态为I或II的成年患者。插管后，继续用氧化亚氮/氧气和异丙酚输注麻醉。经颅电刺激（五列脉冲，刺激强度40-160 mA）通过放置在头皮C3/C4位置的电极引发mep，并使用轴突Sentinel-4EP监测仪在胫骨前肌记录。F波由固定在内踝胫后神经上的电极激发，并在幻觉外展肌记录。异氟烷尾潮浓度保持在0.5% 20 min后，再次测量MEP和F波。采用配对Wilcoxon检验和Bonferroni校正分析异氟醚前后MEP和f波的变化。采用Friedman’s检验分析MEP与F波变化的差异。结果运动诱发电位振幅（中位数，205 &mgr；V； 25 - 75百分位数，120-338 &mgr；V）、f波振幅（中位数，100 &mgr；V； 25 - 75百分位数，64.2-137.5 &mgr；V）和f波持续时间（59±29%）降至0 &mgr；V (0-15 &mgr；V), 49 &mgr；V （12.4-99.6 &mgr；V）和30±31%分别由0.5%异氟烷。MEP振幅抑制与f波振幅和持续时间的变化差异有统计学意义（P < 0.02）。结论0.5%异氟醚通过降低MEP和F波抑制运动通路。MEP比F波受到更大的抑制。
Background Volatile anesthetics produce surgical immobility by suppressing the motor system. The anesthetic action site in the motor pathway is unclear. Anesthetic effects on the whole and the lower portion of motor pathway can be studied by measuring the motor evoked potentials (MEP) and the F wave. This study measured the effect of isoflurane on the MEP and the F wave. Methods With institutional review board approval, we studied 12 adult patients with American Society of Anesthesiologists physical status I or II. After intubation, anesthesia was maintained with nitrous oxide/oxygen and propofol infusion. MEPs were elicited by transcranial electrical stimuli (train-of-five pulse; stimuli intensity 40–160 mA) through electrodes placed in the scalp at C3/C4 positions and recorded at the anterior tibialis muscle with an Axon Sentinel-4EP monitor. F waves were elicited by an electrode fixed over the posterior tibial nerve at the medial malleolus and recorded at the abductor hallucis muscle. After end-tidal concentration of isoflurane was maintained at 0.5% for 20 min, the MEP and F wave were measured again. MEP and F-wave changes before and after isoflurane were analyzed using paired Wilcoxon test with Bonferroni correction. The difference between the changes in MEP and F wave was analyzed using Friedman’s test. Results Motor evoked potential amplitudes (median, 205 &mgr;V; 25th–75th percentiles, 120–338 &mgr;V), F-wave amplitude (median, 100 &mgr;V; 25th–75th percentiles, 64.2–137.5 &mgr;V), and F-wave persistence (59 ± 29%) were decreased to 0 &mgr;V (0–15 &mgr;V), 49 &mgr;V (12.4–99.6 &mgr;V), and 30 ± 31%, respectively, by 0.5% isoflurane. MEP amplitude suppression was different from the changes in F-wave amplitude and persistence (P < 0.02). Conclusions Isoflurane 0.5% suppresses the motor pathway by decreasing both MEP and F wave. The MEP is suppressed more than the F wave.