Anesthetic Fade in Intraoperative Transcranial Motor Evoked Potential Monitoring Is Mainly due to Decreased Synaptic Transmission at the Neuromuscular Junction by Propofol Accumulation.

IF 0.9 4区医学 Q4 CLINICAL NEUROLOGY

Journal of neurological surgery. Part A, Central European neurosurgery Pub Date : 2024-09-01 Epub Date: 2023-05-31 DOI:10.1055/a-2103-7381

Satoshi Tanaka, Kenta Yamamoto, Shinsuke Yoshida, Ryosuke Tomio, Takeshi Fujimoto, Misuzu Osaka, Toshio Ishikawa, Tsunemasa Shimizu, Norio Akao, Terutaka Nishimatsu

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引用次数: 0

Abstract

Background: We previously reported that normalization of motor evoked potential (MEP) monitoring amplitude by compound muscle action potential (CMAP) after peripheral nerve stimulation prevented the expression of anesthetic fade (AF), suggesting that AF might be due to reduced synaptic transfer in the neuromuscular junction.

Methods: We calculated the time at which AF began for each of craniotomy and spinal cord surgery, and examined whether AF was avoided by CMAP after peripheral nerve stimulation normalization in each. Similar studies were also made with respect to the upper and lower limb muscles.

Results: AF was observed in surgery lasting 160 minutes for craniotomy and 260 minutes or more for spinal surgery, and 195 minutes in the upper limb muscles and 135 minutes in the lower limb muscles. In all the series, AF could be avoided by CMAP after peripheral nerve stimulation normalization.

Conclusion: AF of MEP occurred in both craniotomy and spinal cord surgery, and it was also corrected by CMAP after peripheral nerve stimulation. AF is considered to be mainly due to a decrease in synaptic transfer of the neuromuscular junction due to the accumulation of propofol because of the avoidance by CMAP normalization. However, it may be partially due to a decrease in the excitability of pyramidal tracts and α-motor neurons, because AF occurred earlier in the lower limb muscles than in the upper limb muscles.

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术中经颅运动诱发电位监测的麻醉消退主要是由于异丙酚蓄积导致神经肌肉接头处的突触传递减少。

背景：我们以前曾报道过，外周神经刺激后通过复合肌肉动作电位（CMAP）使运动诱发电位（MEP）监测振幅正常化可防止麻醉消退（AF）的表现，这表明AF可能是由于神经肌肉接头的突触传递减少所致：方法：我们计算了开颅手术和脊髓手术的麻醉消退开始时间，并研究了外周神经刺激正常化后的 CMAP 是否能避免麻醉消退。对上肢和下肢肌肉也进行了类似研究：开颅手术持续 160 分钟，脊髓手术持续 260 分钟或更长时间，上肢肌肉持续 195 分钟，下肢肌肉持续 135 分钟，均观察到房颤。在所有系列手术中，外周神经刺激恢复正常后，均可通过 CMAP 避免房颤：结论：开颅手术和脊髓手术中都会出现 MEP 房颤，外周神经刺激后通过 CMAP 也可纠正房颤。AF 被认为主要是由于异丙酚蓄积导致神经肌肉接头的突触传递减少所致，因为 CMAP 正常化可以避免。不过，部分原因可能是锥体束和α-运动神经元的兴奋性降低，因为下肢肌肉发生房颤的时间早于上肢肌肉。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurological surgery. Part A, Central European neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

2.30

自引率

0.00%

发文量

期刊介绍： The Journal of Neurological Surgery Part A: Central European Neurosurgery (JNLS A) is a major publication from the world''s leading publisher in neurosurgery. JNLS A currently serves as the official organ of several national neurosurgery societies. JNLS A is a peer-reviewed journal publishing original research, review articles, and technical notes covering all aspects of neurological surgery. The focus of JNLS A includes microsurgery as well as the latest minimally invasive techniques, such as stereotactic-guided surgery, endoscopy, and endovascular procedures. JNLS A covers purely neurosurgical topics.