Influence of isoflurane on myogenic motor evoked potentials to single and multiple transcranial stimuli during nitrous oxide/opioid anesthesia.
Influence of isoflurane on myogenic motor evoked potentials to single and multiple transcranial stimuli during nitrous oxide/opioid anesthesia.
复制标题
异氟烷对一氧化二氮/阿片类麻醉期间单次和多次经颅刺激的肌源性运动诱发电位的影响。
DOI：
10.1097/00006123-199807000-00058
复制
发表时间：
1998
期刊：
影响因子：
4.8
通讯作者：
H. Been
中科院分区：
文献类型：
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作者：
L. Ubags;C. J. Kalkman;H. Been
客观化
术中应用经颅运动诱发电位(TC-MEP)监测脊髓功能。挥发性麻醉剂显著抑制TC-MEP的波幅。这项研究是为了确定多脉冲刺激是否可以克服这种抑郁效应。
方法
在10名接受脊柱手术的患者中，在一氧化二氮/阿片类麻醉剂方案中加入递增剂量的异氟醚，并在0.2、0.4和0.6%的呼气末保持恒定至少15分钟。从胫前肌记录TC-MEP对单脉冲和三串和五串(刺激间间隔，2ms)经颅电刺激的反应。
结果
在加入异氟醚之前，所有患者都能记录到TC-MEP，即使是单脉冲刺激(中位数幅度，428微V)。在0.2%异氟醚呼气末，8例单次脉冲刺激和3次和5次连续刺激均可记录到TC-MEP。在0.4%异氟醚中，只有一名患者使用单次脉冲刺激，所有患者使用三次和五次刺激时，均可记录到反应。在0.6%异氟醚作用下，除1例患者外，其余患者均可记录到3次和5次刺激的TC-MEP。0.2、0.4和0.6%呼气末异氟醚的反应幅度明显小于对照反应(P<；0.05)。
结论
这些数据表明，尽管异氟醚对肌源性运动反应有很强的抑制作用，但在异氟醚麻醉期间监测TC-MEP可能是可行的，前提是采用多脉冲刺激模式，并且异氟醚的浓度不超过1个最小麻醉浓度单位。
OBJECTIVE
Transcranial motor evoked potentials (tc-MEPs) are used to monitor the spinal cord intraoperatively. Volatile anesthetics considerably depress amplitudes of tc-MEPs. This study was undertaken to determine whether multipulse stimulation might overcome this depressant effect.
METHODS
In 10 patients undergoing spinal surgery, incremental doses of isoflurane were added to a nitrous oxide/opioid anesthetic regimen and maintained constant at 0.2, 0.4, and 0.6% end tidal for at least 15 minutes. tc-MEP responses to single-pulse and trains of three and five (interstimulus interval, 2 ms) transcranial electrical stimuli were recorded from the tibialis anterior muscles.
RESULTS
Before the addition of isoflurane, tc-MEPs were recordable in all patients, even with single-pulse stimuli (median amplitude, 428 microV). With 0.2% end-tidal isoflurane, tc-MEPs were recordable in eight patients with single-pulse stimulation and in all patients with three and five successive stimuli. At 0.4% isoflurane, responses were recordable in only one patient using single-pulse stimuli and in all patients using three and five stimuli. With 0.6% isoflurane, tc-MEPs to trains of three and five stimuli were recordable in all patients except one. The amplitude of the responses obtained with 0.2, 0.4, and 0.6% end-tidal isoflurane was significantly smaller than that of control responses (P < 0.05).
CONCLUSION
These data suggest that despite the powerful depressant effects of isoflurane on myogenic motor responses, tc-MEP monitoring during isoflurane anesthesia may be feasible, provided that multipulse stimulation paradigms are used and the concentration of isoflurane does not exceed 1 minimal anesthetic concentration unit.
北川秀树：“脊柱手术中的磁诱发复合肌肉动作电位神经监测”脊柱。
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