Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report.
Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report.
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DOI：
10.1186/s13256-018-1741-9
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发表时间：
2018-07-13
影响因子：
1
通讯作者：
Baba H
中科院分区：
文献类型：
--
作者：
Furutani K;Matsuhashi M;Deguchi H;Mitsuma Y;Ohashi N;Baba H
据认为，氯胺酮不影响运动诱发电位的幅度，而各种麻醉药则减弱经颅运动诱发电位的幅度。然而，我们遇到了一位静脉推注氯胺酮后运动诱发电位幅度显著减弱的患者。1例15岁日本女孩，被诊断为青少年特发性脊柱侧弯，在本院接受T4-L3后路脊柱融合术。在使用异丙酚和瑞芬太尼持续输注全麻诱导后，我们确认经颅电运动诱发电位被正确记录。氯胺酮1.25 mg/kg静脉注射用于术中、术后镇痛。约3分钟后，运动诱发电位波幅明显减弱。除了氯胺酮，没有使用其他药物。患者生命体征稳定，手术尚未开始。运动诱发电位波幅在注射氯胺酮后约6分钟恢复。手术进行得很顺利，当病人从全身麻醉中苏醒时，她没有神经功能障碍。虽然麻醉学领域普遍认为氯胺酮不会影响运动诱发电位的幅度，但也有人认为氯胺酮可能会影响其监测。
It is believed that ketamine does not affect motor-evoked potential amplitude, whereas various anesthetic drugs attenuate the amplitude of transcranial motor-evoked potential. However, we encountered a patient with marked attenuation of motor-evoked potential amplitude after intravenous bolus administration of ketamine. A 15-year-old Japanese girl with a diagnosis of adolescent idiopathic scoliosis was admitted to our hospital to undergo posterior spinal fusion at T4–L3. After induction of general anesthesia using a continuous infusion of propofol and remifentanil, we confirmed that transcranial electrical motor-evoked potentials were being recorded correctly. Ketamine 1.25 mg/kg was administered intravenously for intraoperative and postoperative analgesia. About 3 minutes later, the motor-evoked potential amplitude was markedly attenuated. No other drugs were administered except for ketamine. The patient’s vital signs were stable, and the surgery had not yet started. The motor-evoked potential amplitude was recovered at about 6 minutes after administration of ketamine. The surgery was performed uneventfully, and the patient had no neurologic deficit when she emerged from general anesthesia. Although there is a widely held belief in the field of anesthesiology that ketamine does not affect motor-evoked potential amplitude, it has been suggested that ketamine could affect its monitoring.