Kitagawa H, Nakamura H, Kawaguchi Y, Tsuji H, Satone T, Takano H, Nakatoh S
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Japan.
Spine (Phila Pa 1976). 1995 Oct 15;20(20):2233-9. doi: 10.1097/00007632-199510001-00010.
Muscle action potentials elicited by paired transcranial magnetic stimulation were recorded during spine surgery in 34 patients. Anesthesia was based on ketamine and fentanyl.
To evaluate the optimal anesthetic regimen to be used for transcranial magnetic stimulation, and to determine the clinical import of magnetic-evoked compound muscle action potentials.
Muscle action potential by transcranial magnetic stimulation has been difficult to record under general anesthesia. Ketamine is known to not suppress the muscle responses, although no conclusive clinical study has been reported.
Paired transcranial magnetic stimulation was delivered as muscle action potentials were recorded from the limb musculature.
Neuromonitoring was reliable in 56% of total cases and in 82% of the recent cases after reducing fentanyl dosage. Paired magnetic stimulation was an excellent facilitation technique for reliable monitoring. At higher dosages, fentanyl and ketamine decreased the reproducibility of the responses.
Magnetic-evoked compound muscle action potential neuromonitoring is a sensitive and selective motor pathway monitoring method that covers the entire motor pathway, including the white and gray matter of the spinal cord. Ketamine-based anesthesia is a good choice for this purpose.
在34例脊柱手术患者中记录了经颅磁刺激诱发的肌肉动作电位。麻醉以氯胺酮和芬太尼为基础。
评估用于经颅磁刺激的最佳麻醉方案，并确定磁诱发复合肌肉动作电位的临床意义。
在全身麻醉下很难记录经颅磁刺激诱发的肌肉动作电位。已知氯胺酮不会抑制肌肉反应，尽管尚无确凿的临床研究报道。
在记录肢体肌肉组织的肌肉动作电位时进行成对经颅磁刺激。
在降低芬太尼剂量后，神经监测在56%的总病例中可靠，在82%的近期病例中可靠。成对磁刺激是一种用于可靠监测的优秀辅助技术。在较高剂量下，芬太尼和氯胺酮会降低反应的可重复性。
磁诱发复合肌肉动作电位神经监测是一种敏感且选择性的运动通路监测方法，涵盖整个运动通路，包括脊髓的白质和灰质。基于氯胺酮的麻醉是实现此目的的良好选择。
