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The influence of nitrous oxide to supplement fentanyl/low-dose propofol anesthesia on transcranial myogenic motor-evoked potentials during thoracic aortic surgery.

Abstract：

OBJECTIVE:Intraoperative monitoring of myogenic motor evoked potentials to transcranial electrical stimulation (tc MEPs) is a new method to assess the integrity of the motor pathways. The authors studied the effects of 50% nitrous oxide (N2O) and a low-dose propofol infusion on tc MEPs paired electrical stimulation during fentanyl anesthesia with partial neuromuscular blockade. DESIGN:Cross-over study. SETTING:St Antonius Hospital, Nieuwegein, The Netherlands. PARTICIPANTS:Ten patients scheduled to undergo surgery on the thoracoabdominal aorta were studied; 6 women aged 54 to 69 years and 4 men aged 68 to 77 years. INTERVENTIONS:After achieving a stable anesthetic state and before surgery, tc MEPs were recorded during four 15-minute periods: (I) air/oxygen (O2; F(I)O2 = 50%); propofol target blood concentration, 0.5 microg/mL; (II) N2O/O2 (F(I)O2 = 50%); propofol target blood concentration, 0.5 microg/mL; (III) N2O/O2 (F(I)O2 = 50%; propofol target blood concentration, 1.0 microg/mL; and (IV) air/O2 (F(I)O2 = 50%); propofol target blood concentration, 1.0 microg/mL. MEASUREMENTS AND MAIN RESULTS:Tc MEPs were recorded from the right extensor digitorum communis muscle and the right tibialis anterior muscle. The right thenar muscle was used for recording the level of relaxation; the T1 response was maintained at 40% to 70% of the control compound muscle action potential. There was no significant difference in onset latency among the four phases. The addition of N2O and doubling the target propofol infusion to 1.0 microg/mL resulted in a 40% to 50% reduction of tc MEP amplitude recorded in the extensor digitorum communis muscle and tibialis anterior muscle (p < 0.01). During each phase, tc MEPs could be elicited and interpreted, except in one patient, in whom no tc MEPs could be elicited in the leg because of technical problems. CONCLUSION:The data indicate that tc MEP monitoring is feasible during low-dose propofol, fentanyl/50% N2O in 02 anesthesia and partial neuromuscular blockade.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

van Dongen EP,ter Beek HT,Schepens MA,Morshuis WJ,Langemeijer HJ,Kalkman CJ,Boezeman EH

doi

10.1016/s1053-0770(99)90169-6

keywords:

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

30-4

issue

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(99)90169-6

journal_volume

pub_type

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The influence of nitrous oxide to supplement fentanyl/low-dose propofol anesthesia on transcranial myogenic motor-evoked potentials during thoracic aortic surgery.