Chaitanya G, Arivazhagan A, Sinha S, Reddy K R Madhusudan, Thennarasu K, Bharath R D, Rao M Bhaskara, Chandramouli B A, Satishchandra P
Department of Clinical Neuroscience, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Epilepsy Res. 2015 Jan;109:65-71. doi: 10.1016/j.eplepsyres.2014.10.006. Epub 2014 Oct 30.
Anesthetic-induced suppression of cortical electrical activity is a major concern during epilepsy surgery. Dexmedetomidine (Dex) has been recently evaluated in a few small series for its effect on the electrocorticographic spikes intra-operatively.
In this prospective study, electrocorticogram (ECoG) was monitored during dexmedetomidine infusion in 34 patients (M:F=23:11, age=29.2 ± 10.9 years; duration of epilepsy=15.3 ± 8.9 years) undergoing anterior temporal lobe resection with amygdalo-hippocampectomy for drug-resistant mesial temporal lobe epilepsy (Right: 18, Left: 16). Anesthesia was induced with thiopental/propofol and maintained with oxygen-N2O-isoflurane. ECoG was recorded for 5 min after the end tidal MAC of N2O and isoflurane were decreased to zero; anesthesia was maintained with O2:Air=50:50, vecuronium and fentanyl. ECoG was recorded using a 4-contact strip electrode for: (a) 5 min prior to dexmedetomidine (PreDEX), (b) 5 min during dexmedetomidine infusion (DEX; 1 μg/kg) and (c) 5 min after stopping dexmedetomidine (PostDEX).
The ECoG spikes were manually counted in all the channels. The mean spike rate in the 2 channels with maximum spikes (MAX CH A and MAX CH B) was normalized to a 3-min duration. RM-ANOVA and post hoc comparison of three phases were used to compare the spike rates. The mean spike rate during Dex phase was higher compared to preDEX (MAX CH B: p=0.007 and MAX CH A: p=0.079) and PostDEX (MAX CH B: p=0.17, MAX CH A: p=0.79) phases. The spike rate increased in 67.6% patients, while 11.8% patients showed ≤ 25% reduction and 20.6% patients showed >25% reduction in spike frequency.
Dexmedetomidine is useful during intra-operative ECoG recording in epilepsy surgery as it enhances or does not alter spike rate in most of the cases, without any major adverse effects.
麻醉诱导的皮质电活动抑制是癫痫手术期间的一个主要问题。右美托咪定（Dex）最近在一些小样本研究中被评估了其对术中皮质脑电图棘波的影响。
在这项前瞻性研究中，对34例接受前颞叶切除加杏仁核-海马切除术治疗耐药性内侧颞叶癫痫（右侧：18例，左侧：16例）的患者（男:女 = 23:11，年龄 = 29.2 ± 10.9岁；癫痫病程 = 15.3 ± 8.9年）在输注右美托咪定期间进行皮质脑电图（ECoG）监测。麻醉诱导采用硫喷妥钠/丙泊酚，维持采用氧气-氧化亚氮-异氟烷。在呼气末氧化亚氮和异氟烷的最低肺泡有效浓度（MAC）降至零时记录5分钟的ECoG；麻醉维持采用氧气:空气 = 50:50、维库溴铵和芬太尼。使用4触点条形电极记录ECoG用于：（a）右美托咪定给药前5分钟（PreDEX），（b）右美托咪定输注期间5分钟（DEX；1 μg/kg），以及（c）停止右美托咪定后5分钟（PostDEX）。
在所有通道手动计数ECoG棘波。将棘波最多的2个通道（MAX CH A和MAX CH B）的平均棘波率标准化为3分钟时长。采用重复测量方差分析（RM-ANOVA）和三个阶段的事后比较来比较棘波率。与PreDEX阶段（MAX CH B：p = 0.007，MAX CH A：p = 0.079）和PostDEX阶段（MAX CH B：p = 0.17，MAX CH A：p = 0.79）相比，Dex阶段的平均棘波率更高。67.6%的患者棘波率增加，而11.8%的患者棘波频率降低≤25%，20.6%的患者棘波频率降低>25%。
右美托咪定在癫痫手术术中ECoG记录期间是有用的，因为在大多数情况下它会提高或不改变棘波率，且无任何重大不良反应。
