Anaesthesiology, Reanimation, and Pain Therapy Unit, Parc de Salut MAR, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
Neurology Unit, Neurophysiologic Section, Parc de Salut MAR, Barcelona, Spain.
Acta Anaesthesiol Scand. 2021 Sep;65(8):1043-1053. doi: 10.1111/aas.13835. Epub 2021 May 12.
Dexmedetomidine is used as adjuvant in total intravenous anaesthesia (TIVA), but there have been few studies concerning its effect on intraoperative neurophysiological monitoring (IONM) during cranial surgery. Our aim was to study the effect of dexmedetomidine on IONM in patients undergoing brain stem and supratentorial cranial surgery.
Two prospective, randomized, double-blind substudies were conducted. In substudy 1, during TIVA with an infusion of propofol and remifentanil, 10 patients received saline solution (SS) (PR group) and another 10 (PRD group) received dexmedetomidine (0.5 mcg/kg/h). Total dosage of propofol and remifentanil, intensity, latency and amplitude of motor-evoked potentials following transcranial electrical stimulation (tcMEPs) as well as somatosensory-evoked potentials (SSEP) were recorded at baseline, 15, 30, 45 minutes, and at the end of surgery. In order to identify differences in the same patient after dexmedetomidine administration, we designed substudy 2 with 20 new patients randomized to two groups. After 30 minutes with TIVA, 10 patients received dexmedetomidine (0.5 mcg/kg/h) and 10 patients SS. The same variables were recorded.
In substudy 1, propofol requirements were significantly lower (P = .004) and tcMEP intensity at the end of surgery was significantly higher in PRD group, but no statistically significant differences were observed for remifentanil requirements, SSEP and tcMEP latency or amplitude. In substudy 2, no differences in any of the variables were identified.
The administration of dexmedetomidine at a dosage of 0.5 mg/kg/h may reduce propofol requirements and adversely affect some neuromonitoring variables. However, it can be an alternative on IONM during cranial surgeries. REDEX EudraCT: 2014-000962-23.
右美托咪定在全凭静脉麻醉（TIVA）中被用作辅助药物，但关于其在颅外科手术期间对术中神经生理监测（IONM）的影响的研究甚少。我们的目的是研究右美托咪定对接受脑干和颅顶手术的患者 IONM 的影响。
进行了两项前瞻性、随机、双盲子研究。在子研究 1 中，在输注丙泊酚和瑞芬太尼的 TIVA 期间，10 名患者接受生理盐水溶液（SS）（PR 组），而另 10 名患者（PRD 组）接受右美托咪定（0.5mcg/kg/h）。记录基础状态、15、30、45 分钟和手术结束时经颅电刺激（tcMEPs）后运动诱发电位的总丙泊酚和瑞芬太尼剂量、强度、潜伏期和振幅，以及体感诱发电位（SSEP）。为了识别给药后同一患者的差异，我们设计了子研究 2，其中 20 名新患者随机分为两组。在 TIVA 30 分钟后，10 名患者接受右美托咪定（0.5mcg/kg/h），10 名患者接受 SS。记录相同的变量。
在子研究 1 中，PRD 组丙泊酚需求量明显较低（P=0.004），手术结束时 tcMEP 强度明显较高，但瑞芬太尼需求量、SSEP 和 tcMEP 潜伏期或振幅无统计学差异。在子研究 2 中，未发现任何变量存在差异。
以 0.5mg/kg/h 的剂量给予右美托咪定可能会降低丙泊酚的需求量，并对某些神经监测变量产生不利影响。然而，它可能是颅外科手术期间 IONM 的替代方法。REDEX EudraCT：2014-000962-23。
