Propofol reduces the amplitude of transcranial electrical motor-evoked potential without affecting spinal motor neurons: a prospective, single-arm, interventional study
Propofol reduces the amplitude of transcranial electrical motor-evoked potential without affecting spinal motor neurons: a prospective, single-arm, interventional study
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DOI：
10.1007/s00540-021-02927-7
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发表时间：
2021-04-07
影响因子：
2.8
通讯作者：
Baba, Hiroshi
中科院分区：
文献类型：
--
作者：
Deguchi, Hiroyuki;Furutani, Kenta;Baba, Hiroshi
目的异丙酚对经颅运动诱发电位（TCE-MEP）的振幅有剂量依赖性的抑制作用。然而，这种影响的机制仍然未知。因此，我们研究了异丙酚对TCE-MEP振幅的抑制作用的脊髓机制，通过评估诱发肌电图（H反射和F波）在全身麻醉下。方法我们进行了一项前瞻性、单组、介入性研究，包括15例拟在全身麻醉下进行脊柱手术的患者。比目鱼肌和TCE-MEP的诱发肌电图测量在三个丙泊酚浓度使用靶控输注（TCI：2.0，3.0，和4.0 μ g/mL）。主要结果测量是TCI为4.0与2.0 μ g/mL丙泊酚给药期间的左侧H反射振幅。结果4.0和2.0 μ g/mL TCI组左侧H反射的中位[四分位距]幅度分别为4.71 [3.42-6.60]和5.6 [4.17-7.46]（p = 0.4，Friedman检验）。各组间右侧H反射和双侧F波振幅无显著差异。然而，随着丙泊酚浓度的增加，TCE-MEP幅度显著降低（p < 0.001，Friedman检验）。结论异丙酚对H反射和F波振幅无明显影响，但在较高浓度时，TCE-MEP振幅降低。这些结果表明，异丙酚对脊髓上运动通路的抑制作用比对脊髓运动神经元兴奋性的抑制作用更强，从而抑制TCE-MEP振幅。
Purpose Propofol inhibits the amplitudes of transcranial electrical motor-evoked potentials (TCE-MEP) in a dose-dependent manner. However, the mechanisms of this effect remain unknown. Hence, we investigated the spinal mechanisms of the inhibitory effect of propofol on TCE-MEP amplitudes by evaluating evoked electromyograms (H-reflex and F-wave) under general anesthesia. Methods We conducted a prospective, single-arm, interventional study including 15 patients scheduled for spine surgery under general anesthesia. Evoked electromyograms of the soleus muscle and TCE-MEPs were measured at three propofol concentrations using target-controlled infusion (TCI: 2.0, 3.0, and 4.0 mu g/mL). The primary outcome measure was the left H-reflex amplitude during TCI of 4.0- compared to 2.0-mu g/mL propofol administration. Results The median [interquartile range] amplitudes of the left H-reflex were 4.71 [3.42-6.60] and 5.6 [4.17-7.46] in the 4.0- and 2.0-mu g/mL TCI groups (p = 0.4, Friedman test), respectively. There were no significant differences in the amplitudes of the right H-reflex and the bilateral F-wave among these groups. However, the TCE-MEP amplitudes significantly decreased with increased propofol concentrations (p < 0.001, Friedman test). Conclusion Propofol did not affect the amplitudes of the H-reflex and the F-wave, whereas TCE-MEP amplitudes were reduced at higher propofol concentrations. These results suggested that propofol can suppress the TCE-MEP amplitude by inhibiting the supraspinal motor pathways more strongly than the excitability of the motor neurons in the spinal cord.