Laureau E, Marciniak B, Hébrard A, Herbaux B, Guieu J D
Service de Neurophysiologie Clinique, Centre Hospitalier Régional et Universitaire de Lille, France.
Neurosurgery. 1999 Jul;45(1):69-74; discussion 75. doi: 10.1097/00006123-199907000-00017.
Studies of the effects on lower-limb cortical somatosensory evoked potentials (CSEP) during total intravenous anesthesia are sparse for propofol and are lacking for midazolam. This study was designed to compare the effects of propofol and midazolam on CSEP under total intravenous anesthesia during intraoperative monitoring for surgical treatment of scoliosis.
CSEPs were recorded in two groups of 15 patients during posterior instrumentation for treatment of idiopathic scoliosis. The anesthesia used the combination of atracurium, alfentanil, and an hypnotic agent (propofol for Group I or midazolam for Group II). The main characteristics of the CSEPs (P40 latency and N34-P40 and P40-N50 amplitudes) were recorded using ankle posterior tibial nerve stimulation. The CSEPs were recorded before induction, 10, 70, 100, 130, and 160 minutes after induction, and before the wake-up test. The statistical analysis involved analysis of variance for repeated measures. Both groups were homogeneous before induction.
Neither CSEP deterioration during risk-associated surgical procedures nor postoperative clinical abnormalities were observed. Both propofol and midazolam induced increases in P40 latencies, with the increases being greater and more regular for the propofol-treated group. The amplitude values changed with time for both groups, decreasing mainly after induction; in the midazolam-treated group, the amplitudes were smaller but more stable. Propofol modified the morphological characteristics of the response by decreasing the late P60 component amplitude; the W-shaped CSEP morphological pattern was maintained with midazolam.
This study demonstrates the appropriate use of either propofol or midazolam in scoliosis monitoring. Preoperative small-amplitude CSEPs might favor the use of propofol anesthesia.
关于全静脉麻醉期间丙泊酚对下肢皮质体感诱发电位（CSEP）影响的研究较少，而关于咪达唑仑的此类研究则尚无报道。本研究旨在比较丙泊酚和咪达唑仑在全静脉麻醉下用于脊柱侧弯手术治疗术中监测时对CSEP的影响。
两组各15例患者在进行后路器械治疗特发性脊柱侧弯手术时记录CSEP。麻醉采用阿曲库铵、阿芬太尼和一种催眠药联合使用（第一组用丙泊酚，第二组用咪达唑仑）。使用踝部胫后神经刺激记录CSEP的主要特征（P40潜伏期以及N34 - P40和P40 - N50波幅）。在诱导前、诱导后10、70、100、130和160分钟以及苏醒测试前记录CSEP。统计分析采用重复测量方差分析。两组在诱导前具有同质性。
在与风险相关的手术过程中未观察到CSEP恶化，术后也未出现临床异常。丙泊酚和咪达唑仑均导致P40潜伏期延长，丙泊酚治疗组的延长幅度更大且更规律。两组的波幅数值均随时间变化，主要在诱导后降低；在咪达唑仑治疗组，波幅较小但更稳定。丙泊酚通过降低晚期P60成分波幅改变了反应的形态特征；咪达唑仑则维持了W形CSEP形态模式。
本研究表明丙泊酚或咪达唑仑在脊柱侧弯监测中均可适当使用。术前小波幅CSEP可能更适合使用丙泊酚麻醉。
