Nagarajan Lakshmi, Ghosh Soumya, Dillon David, Palumbo Linda, Woodland Peter, Thalayasingam Priya, Lethbridge Martyn
Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia.
Clin Neurophysiol Pract. 2019 Jan 25;4:11-17. doi: 10.1016/j.cnp.2018.12.002. eCollection 2019.
Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice.
We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries.
INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics.
INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets - amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM.
Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option.
术中神经生理学监测（INM）被认为可降低接受脊柱侧弯和脊柱畸形手术儿童术后神经功能缺损的风险。尽管存在意见分歧、结果各异、警报标准不统一以及对成本效益的担忧，但INM的使用却越来越多。在本文中，我们介绍了我们在儿童脊柱侧弯和脊柱畸形手术中使用INM的经验，提出了临床实践中的警报标准和首选麻醉方法。
我们回顾性分析了我们对56例接受61次脊柱侧弯和脊柱畸形手术的儿童使用INM的经验。
经颅电运动诱发电位（TcMEP）和体感诱发电位成功进行了INM监测。未发生因INM导致的损伤。4名儿童在4次手术中有5次警报。仅1名儿童出现术后神经功能缺损。在INM期间未出现警报的儿童中，没有发现新的术后神经功能缺损。与吸入麻醉剂相比，全静脉麻醉更适合INM。
INM在脊柱侧弯手术中有用；它可能会降低术后出现新的神经功能缺损的风险。我们推荐针对TcMEP的警报标准，包括多个方面——波幅、刺激模式、形态。我们推荐在INM期间麻醉时使用丙泊酚和瑞芬太尼，而不是七氟烷和瑞芬太尼。
我们的研究为支持INM在儿童脊柱侧弯手术中的作用的文献增添了内容。我们提供了临床实践中警报标准的指南，并推荐使用全静脉麻醉作为首选的麻醉方法。
