右美托咪定对异丙酚-七氟醚联合麻醉下接受开颅手术患者的体感和运动诱发电位的影响

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-07-09 DOI:10.3389/fsurg.2024.1386049

Xue Yang, Xinyi Zhang, Puxuan Lin, Zeheng Liu, Shuhang Deng, Shanwen Liang, Xinyi Zhu, Qianqian Qiao, Qianxue Chen

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引用次数: 0

摘要

简介：右美托咪定通常作为全静脉麻醉（TIVA）的辅助用药，用于需要术中神经电生理监测（IONM）的手术。方法我们回顾了武汉大学人民医院神经外科2019年3月至2021年3月期间47例接受手术和术中神经电生理监测的患者的术中神经电生理监测数据。记录并分析了术前和术后的运动功能评分。结果我们发现，右美托咪定组的经颅运动诱发电位（Tce-MEPs）振幅显著低于阴性对照组（P &p;lt;0.0001）。体感诱发电位（SSEPs）振幅、Tce-MEPs 或 SSEPs 潜伏期在统计学上没有明显差异。与术前相比，右美托咪定组的术后运动功能没有明显下降，这表明没有证据表明右美托咪定会影响患者的预后。讨论虽然右美托咪定不会影响开颅手术患者的预后，但在开颅手术中将其作为辅助用药的潜在风险和益处应仔细评估。使用右美托咪定时，应监测 Tce-MEPs。当检测到 Tce-MEPs 振幅减小时，可通过 MEPs 振幅是否双侧减小来间接确定其原因。

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Effect of dexmedetomidine on somatosensory- and motor-evoked potentials in patients receiving craniotomy under propofol-sevoflurane combined anesthesia

IntroductionDexmedetomidine is often used as an adjunct to total intravenous anesthesia (TIVA) for procedures requiring intraoperative neurophysiologic monitoring (IONM). However, it has been reported that dexmedetomidine might mask the warning of a neurological deficit on intraoperative monitoring.MethodsWe reviewed the intraoperative neurophysiological monitoring data of 47 patients who underwent surgery and IONM from March 2019 to March 2021 at the Department of Neurosurgery, Renmin Hospital of Wuhan University. Pre- and postoperative motor function scores were recorded and analyzed. Dexmedetomidine was administered intravenously at 0.5 μg/kg/h 40 min after anesthesia and discontinued after 1 h in the dexmedetomidine group.ResultsWe found that the amplitude of transcranial motor-evoked potentials (Tce-MEPs) was significantly lower in the dexmedetomidine group than in the negative control group (P < 0.0001). There was no statistically significant difference in the somatosensory-evoked potentials (SSEPs) amplitude or the Tce-MEPs or SSEPs latency. There was no significant decrease in postoperative motor function in the dexmedetomidine group compared with the preoperative group, suggesting that there is no evidence that dexmedetomidine affects patient prognosis. In addition, we noticed a synchronized bilateral decrease in the Tce-MEPs amplitude in the dexmedetomidine group and a mostly unilateral decrease on the side of the brain injury in the positive control group (P = 0.001).DiscussionAlthough dexmedetomidine does not affect the prognosis of patients undergoing craniotomy, the potential risks and benefits of applying it as an adjunctive medication during craniotomy should be carefully evaluated. When dexmedetomidine is administered, Tce-MEPs should be monitored. When a decrease in the Tce-MEPs amplitude is detected, the cause of the decrease in the MEPs amplitude can be indirectly determined by whether the decrease is bilateral.

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.