Cortical somatosensory-evoked potentials during spine surgery in patients with neuromuscular and idiopathic scoliosis under propofol-remifentanil anaesthesia
Cortical somatosensory-evoked potentials during spine surgery in patients with neuromuscular and idiopathic scoliosis under propofol-remifentanil anaesthesia
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DOI：
10.1093/bja/ael365
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发表时间：
2007-03-01
影响因子：
9.8
通讯作者：
Stevens, M. F.
中科院分区：
文献类型：
--
作者：
Hermanns, H.;Lipfert, P.;Stevens, M. F.
背景。术中通过皮质体感诱发电位（SSEP）监测脊髓是脊柱手术中的常规。然而，特别是在神经肌肉性脊柱侧凸中，皮质SSEP的可靠性一直受到质疑。因此，我们比较了皮质SSEP在特发性和神经肌肉性脊柱侧凸中使用麻醉剂的可行性，已知麻醉剂对SSEP记录的影响很小。所有患者均以异丙酚和瑞芬太尼连续输注全静脉麻醉。对54例脊柱畸形手术患者的正中神经和胫神经皮质SSEP进行监测。27例为特发性脊柱侧凸，27例为神经肌肉性脊柱侧凸。比较两组可重复性结果及术中变化的比例。在两组中，皮质SSEP都能得到足够可靠的监测。仅在2例特发性和4例神经肌肉性脊柱侧凸患者中没有可重复的痕迹。神经肌肉型脊柱侧凸患者的振幅低于特发性脊柱侧凸患者，但无统计学意义。术后无神经功能缺损。假阳性和真阳性的数量在两组之间没有差异。脊柱手术期间皮质SSEP的评估在神经肌肉性脊柱侧凸患者和特发性脊柱侧凸患者中同样有效和可靠，这可能是异丙酚-瑞芬太尼麻醉的结果。
Background. Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potentials (SSEP) is a routine during spinal surgery. However, especially in neuromuscular scoliosis, the reliability of cortical SSEP has been questioned. Therefore, we compared the feasibility of cortical SSEP in idiopathic and neuromuscular scoliosis using anaesthetics known to have only minimal effect on SSEP recordings.Methods. Total intravenous anaesthesia with propofol and remifentanil as continuous infusion was standardized for all the patients. Median and tibial nerve cortical SSEP were monitored in 54 patients who underwent surgery for spinal deformity. Twenty-seven had idiopathic scoliosis and 27 had neuromuscular scoliosis. The portion of reproducible results and intratoperative changes were compared between the groups.Results. In both groups, cortical SSEP could be monitored with sufficient reliability. Only in two patients with idiopathic and four patients with neuromuscular scoliosis no reproducible traces could be obtained. The amplitudes in patients with neuromuscular scoliosis were lower than in those with idiopathic scoliosis, but not statistically significant. There were no postoperative neurological deficits. The number of false positive and true positive did not differ between the groups.Conclusions. Assessment of cortical SSEP during spine surgery was equally effective and reliable in patients with neuromuscular scoliosis and in patients with idiopathic scoliosis, possibly as a result of propofol-remifentanil anaesthesia.