Yamada Shoto, Chaki Tomohiro, Enatsu Rei, Kimura Yusuke, Hirahata Tomoki, Takahashi Yasuhiro, Yamaoka Ayumu, Komatsu Katsuya, Akiyama Yukinori, Mikami Takeshi, Mikuni Nobuhiro, Yamakage Michiaki
Division of Clinical Engineering, Sapporo Medical University Hospital, South 1, West 16, Chuo-Ku, Sapporo-Shi, Hokkaido, 060-8543, Japan.
Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-Ku, Sapporo-Shi, Hokkaido, 060-8543, Japan.
J Anesth. 2025 Sep 17. doi: 10.1007/s00540-025-03571-1.
The aim of this study was to determine the feasibility of intraoperative motor function monitoring using motor-evoked potential (MEP) in combination with low-concentration sevoflurane during propofol anesthesia.
This study was a prospective, non-randomized trial that included 38 patients undergoing neurosurgery. MEP were performed under age-adjusted 0, 0.2, and 0.5 minimum alveolar concentrations (MACs) of additional sevoflurane inhalation on propofol anesthesia sequentially. MEP monitoring positive rate, amplitude, latency, and physiological variables were compared between the sections.
The percentages of monitoring positive rate with additional 0.2 and 0.5 MACs of sevoflurane were 86.8% and 36.8%, respectively [p < 0.001, 0.5 MAC; relative risk = 0.424, 95% confidence interval (CI) 0.275-0.655]. The amplitudes and latency were significantly decreased and prolonged with sevoflurane administration and increasing MAC. Areas under the curve for 0.2 and 0.5 MACs of sevoflurane were 0.976 (95% CI 0.923-1.000) and 0.857 (95% CI 0.740-0.974), respectively. The best cutoff values were 462.3 µV and 820.6 µV, respectively.
Results suggested that combined anesthetic management can be performed if the amplitude is higher than the cutoff values.
本研究旨在确定在丙泊酚麻醉期间，使用运动诱发电位（MEP）联合低浓度七氟醚进行术中运动功能监测的可行性。
本研究为前瞻性、非随机试验，纳入38例接受神经外科手术的患者。在丙泊酚麻醉基础上，依次吸入年龄校正后的0、0.2和0.5最低肺泡浓度（MAC）的额外七氟醚时进行MEP监测。比较各阶段MEP监测阳性率、波幅、潜伏期及生理变量。
额外吸入0.2 MAC和0.5 MAC七氟醚时的监测阳性率分别为86.8%和36.8%[p < 0.001，0.5 MAC；相对危险度=0.424，95%置信区间（CI）0.275 - 0.655]。随着七氟醚给药及MAC增加，波幅显著降低，潜伏期显著延长。0.2 MAC和0.5 MAC七氟醚的曲线下面积分别为0.976（95% CI 0.923 - 1.000）和0.857（95% CI 0.740 - 0.974）。最佳截断值分别为462.3 μV和820.6 μV。
结果表明，如果波幅高于截断值，则可进行联合麻醉管理。
