Benuska J, Plisova M, Zabka M, Horvath J, Tisovsky P, Novorolsky K
Bratisl Lek Listy. 2019;120(10):794-801. doi: 10.4149/BLL_2019_133.
Intraoperative neuromonitoring using tc-MEPs satisfactorily detects motor tract integrity changes during spinal surgery. However, tc-MEP is affected by anesthesia and other factors, in which the stimulation threshold increases because the waveform amplitude decreases over time with the accumulation and boluses of anesthetics.
We conducted a retrospective study of 139 patients. The average age was 30 years. Tc-MEPs were recorded bilaterally from the tibialis anterior muscle and the abductor hallucis muscle. Statistical tests were used to investigate the changes to evaluate anesthetic effects.
There were no significant differences in tc-MEP amplitude change (%) between the groups of propofol (13 %), remifentanil (22 %) and sufentanil (26 %, p < 0.01). Significant differences were found between the groups of propofol, remifentanil, and sufentanil (20 %) and bolus sufentanil (‒30 %), and bolus ketamine (730 %, p < 0.008). Major differences were observed between bolus sufentanil (‒30 %) and bolus ketamine (730 %, p < 0.001). When comparing tc-MEPs with no amplitude, no significant difference was found between the groups of propofol (26 %), remifentanil (24 %), and sufentanil (28 %, p < 0.007). Substantial difference was found between the groups of propofol, remifentanil, and sufentanil (mean 26 %) and the group where ketamine boluses were administered. We didn't observe any loss of amplitude (0 %, p < 0.0002).
IONM may be useless in patients where boluses of sufentanil are administered and also with Medical Research Council grades 3 and below. Consider applying IONM in patients with severe spinal deformity along with a higher age of over 50 and neurological deficit. Increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of tc-MEP. Our concept of findings supports the neurophysiological monitoring findings in other studies (Tab. 10, Ref. 45).
在脊柱手术中，使用经颅运动诱发电位（tc-MEPs）进行术中神经监测能够令人满意地检测运动传导束完整性的变化。然而，tc-MEP会受到麻醉及其他因素的影响，其中随着麻醉剂的累积和推注，波形幅度会随时间降低，刺激阈值升高。
我们对139例患者进行了一项回顾性研究。平均年龄为30岁。从双侧胫前肌和拇展肌记录tc-MEPs。使用统计检验来研究这些变化以评估麻醉效果。
丙泊酚组（13%）、瑞芬太尼组（22%）和舒芬太尼组（26%，p<0.01）之间的tc-MEP幅度变化（%）无显著差异。在丙泊酚、瑞芬太尼和舒芬太尼组（20%）与舒芬太尼推注组（-30%）以及氯胺酮推注组（730%，p<0.008）之间发现了显著差异。在舒芬太尼推注组（-30%）和氯胺酮推注组（730%，p<0.001）之间观察到主要差异。当比较无幅度的tc-MEPs时，丙泊酚组（26%）、瑞芬太尼组（24%）和舒芬太尼组（28%，p<0.007）之间未发现显著差异。在丙泊酚、瑞芬太尼和舒芬太尼组（平均26%）与给予氯胺酮推注的组之间发现了实质性差异。我们未观察到任何幅度丧失（0%，p<0.0002）。
在给予舒芬太尼推注的患者以及医学研究委员会分级为3级及以下的患者中，术中神经监测可能无用。考虑在年龄超过50岁且有神经功能缺损的严重脊柱畸形患者中应用术中神经监测。可考虑增加刺激强度或采用易化技术以提高tc-MEP的有效性。我们的研究结果概念支持其他研究中的神经生理监测结果（表10，参考文献45）。
