Hashimoto Yuko, Gotanda Yuki, Ito Takahiko, Ushijima Kazuo
Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011.
Masui. 2011 Aug;60(8):968-71.
Motor evoked potential (MEP) monitoring has been employed to detect the spinal cord injury during spinal, neurosurgical and cardiovascular operations. Muscle relaxants diminish the amplitude of MEP because MEP is the picture of electromyogram. In 5 cases undergoing MEP monitoring, we examined the effect of rocuronium followed by the administration of sugammadex on MEP Anesthesia was induced with propofol (target controlled infusion 3.0-3.5 microg x ml(-1)) and remifentanil 0.15-0.3 microg x kg(-1) x min(-1), and the trachea was intubated with the use of rocuronium 0.6 mg x kg(-1) without any muscle rigidity, bucking and laryngospasm. General anesthesia was maintained by total intravenous anesthesia using propofol and remifentanil with no muscle relaxants. Immediately after the tracheal intubation, sugammadex 4 mg x kg(-1) was intravenously given. The amplitude of MEP was measured just before the administration of rocuronium, immediately after the tracheal intubation, and 1, 2, 3, 5 min following the administration of sugammadex. Sugammadex restored the MEP amplitude, deteriorated by rocuronium, in 3 to 5 min to the level of non-paralytic muscles. In one case, it took 8 min to restore the MEP of hemiparetic leg. Taking these findings into consideration, it is likely that rocuronium might not affect the MEP when reversed by sugammadex, and should be safe for smooth tracheal intubation in patients who need MEP monitoring.
运动诱发电位（MEP）监测已被用于在脊柱、神经外科和心血管手术中检测脊髓损伤。肌肉松弛剂会降低MEP的幅度，因为MEP是肌电图的表现形式。在5例接受MEP监测的患者中，我们研究了罗库溴铵给药后再给予舒更葡糖对MEP的影响。采用丙泊酚（靶控输注3.0 - 3.5微克/毫升）和瑞芬太尼0.15 - 0.3微克/千克/分钟诱导麻醉，使用0.6毫克/千克的罗库溴铵进行气管插管，未出现任何肌肉强直、呛咳和喉痉挛。采用丙泊酚和瑞芬太尼全静脉麻醉维持全身麻醉，不使用肌肉松弛剂。气管插管后立即静脉给予4毫克/千克的舒更葡糖。在给予罗库溴铵前、气管插管后即刻以及给予舒更葡糖后1、2、3、5分钟测量MEP的幅度。舒更葡糖在3至5分钟内将因罗库溴铵降低的MEP幅度恢复至非麻痹肌肉的水平。在1例患者中，恢复偏瘫侧下肢的MEP幅度用时8分钟。考虑到这些发现，罗库溴铵在被舒更葡糖逆转时可能不会影响MEP，对于需要MEP监测的患者，在进行气管插管时应该是安全的。
