Neuroanesthesia Guidelines for Optimizing Transcranial Motor Evoked Potential Neuromonitoring During Deformity and Complex Spinal Surgery A Delphi Consensus Study
Neuroanesthesia Guidelines for Optimizing Transcranial Motor Evoked Potential Neuromonitoring During Deformity and Complex Spinal Surgery A Delphi Consensus Study
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DOI：
10.1097/brs.0000000000003433
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发表时间：
2020-07-01
期刊：
影响因子：
3
通讯作者：
Uribe, Juan S.
中科院分区：
文献类型：
--
作者：
Walker, Corey T.;Kim, Han Jo;Uribe, Juan S.
研究设计.专家意见修正的德尔菲研究。Objective.我们采用改良的德尔菲法在脊柱畸形外科医生及其神经麻醉团队中就获得可靠运动诱发电位（MEP）信号的最佳实践达成共识。背景数据总结。经颅MEP的术中神经生理监测为复杂脊柱手术中评估脊髓完整性提供了最佳方法。MEP受药理学和生理学参数的影响。脊柱外科医生和神经麻醉团队有责任了解他们如何在整个手术过程中最好地保持高质量的MEP信号。然而，在临床实践中，可以看到不同的神经麻醉方法。方法.我们确定了19个国际脊柱畸形治疗专家团队。一个修改后的德尔菲过程进行了两轮调查。对最终声明的一致性超过50%被视为“一致”;一致性超过75%被视为“共识”。“结果。从专家中心获得麻醉方案和方案。各中心之间存在大量变异性。进行了两轮共识调查，所有中心均参与了两轮调查。15项声明中有12项获得协商一致意见，其余两项声明获得多数同意。全静脉麻醉被确定为首选的维持方法，少数中心允许吸入麻醉剂的平均肺泡浓度较低。大多数中心主张
Study Design. Expert opinion-modified Delphi study. Objective. We used a modified Delphi approach to obtain consensus among leading spinal deformity surgeons and their neuroanesthesiology teams regarding optimal practices for obtaining reliable motor evoked potential (MEP) signals. Summary of Background Data. Intraoperative neurophysiological monitoring of transcranial MEPs provides the best method for assessing spinal cord integrity during complex spinal surgeries. MEPs are affected by pharmacological and physiological parameters. It is the responsibility of the spine surgeon and neuroanesthesia team to understand how they can best maintain high-quality MEP signals throughout surgery. Nevertheless, varying approaches to neuroanesthesia are seen in clinical practice. Methods. We identified 19 international expert spinal deformity treatment teams. A modified Delphi process with two rounds of surveying was performed. Greater than 50% agreement on the final statements was considered "agreement"; >75% agreement was considered "consensus." Results. Anesthesia regimens and protocols were obtained from the expert centers. There was a large amount of variability among centers. Two rounds of consensus surveying were performed, and all centers participated in both rounds of surveying. Consensus was obtained for 12 of 15 statements, and majority agreement was obtained for two of the remaining statements. Total intravenous anesthesia was identified as the preferred method of maintenance, with few centers allowing for low mean alveolar concentration of inhaled anesthetic. Most centers advocated for