What Can We Learn From Two Consecutive Cases? Droperidol May Abolish TcMEPs.
What Can We Learn From Two Consecutive Cases? Droperidol May Abolish TcMEPs.
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从连续两个案例中我们可以学到什么？
DOI：
10.5152/tjar.2016.50336
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发表时间：
2017
影响因子：
0.5
通讯作者：
J. Á. Torres Dios
中科院分区：
文献类型：
--
作者：
Ángel Saponaro González;P. J. Pérez Lorensu;S. Chaves Gómez;Josué Francisco Nodarse Medina;J. Á. Torres Dios
氟哌利多是一种D2受体拮抗剂，目前在欧洲用于预防术后恶心和呕吐。它被用于与芬太尼联合进行neurolept麻醉，直到2001年美国食品和药物管理局（FDA）的“黑匣子”警告由于心血管副作用而限制其使用。目前尚无关于氟哌利多对电刺激诱发的经颅运动诱发电位（TcMEP）影响的文献。我们的目的是报告两例脊柱手术中，TcMEP丢失，由于氟哌利多管理。我们报告一位4岁男性脊柱侧凸接受矫正，一位58岁女性D8椎体转移瘤接受脊柱后凸矫正。术中通过TcMEP和体感诱发电位（SEP）进行神经生理监测。术中神经生理监测（IONM）显示TcMEP暂时丧失，无SEP变化，与氟哌利多给药一致。将TcMEP刺激参数改变为双脉冲串，目的是引起它们，获得反应。氟哌利多给药后5分钟，TcMEP等于基线时的TcMEP。氟哌利多用于预防术后恶心可消除TcMEP。将刺激参数改变为双脉冲串，它允许绕过氟哌利多中枢作用，实现可监测的TcMEP。
Droperidol is a D2 receptor antagonist currently used in Europe for preventing postoperative nausea and vomiting. It was used to perform neurolept anaesthesia in combination with fentanyl until a Food and Drug Administration (FDA) 'black box' warning restricted its use due to cardiovascular side effects in 2001. There is no literature regarding the effects of droperidol on transcranial motor evoked potentials (TcMEPs) elicited by electrical stimulation. Our aim was to report two cases of spine surgery in which TcMEPs were lost due to droperidol administration. We report the cases of a 4-year-old male with scoliosis undergoing correction and a 58-year-old woman with metastasis on the D8 vertebrae undergoing kyphosis correction. Intraoperative neurophysiological monitoring was achieved through TcMEPs and somatosensory evoked potentials (SEPs). Intraoperative neurophysiological monitoring (IONM) showed a temporal loss of TcMEPs without SEPs changes coinciding with the administration of droperidol. TcMEP stimulation parameters were changed to double train of pulses, with the aim to elicit them, obtaining responses. Five minutes after droperidol administration, TcMEPs were equal to those at baseline. Droperidol used as prophylaxis for postoperative nausea abolishes TcMEPs. Changing stimulation parameters to double train of pulses, it allows to bypass droperidol central action, achieving monitorable TcMEPs.