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Feasibility and diagnostic accuracy of intra-operative monitoring of motor evoked potentials in children <2 years of age undergoing tethered cord surgery: results in 100 children

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Abstract

Objective

This study documents the monitorability using different anesthesia regimes and accuracy of muscle motor evoked potentials (mMEPs) in children ≤2 years of age undergoing tethered cord surgery (TCS).

Methods

Intraoperative mMEP monitoring was attempted in 100 consecutive children, ≤2 years of age, undergoing TCS. MEP monitoring was done under 4 different anesthetic regimes: (Total intravenous anesthesia (TIVA); balanced anesthesia with sevoflurane and ketamine; balanced anesthesia with isoflurane and ketamine; and balanced anesthesia with sevoflurane). Factors analyzed for their effect on monitorability were: age, neurological deficits, type of anesthesia, and the number of pulses used for stimulation.

Results

Baseline mMEPs were obtained in 87% children. Monitorability of mMEPs was similar in children ≤1 year and 1-2 years of age (85.7% and 87.5%). In multivariate analysis, anesthesia regime was the only significant factor predicting presence of baseline mMEPs. Children undergoing TIVA (p=0.02) or balanced anesthesia with a combination of propofol, sevoflurane, and ketamine (p=0.05) were most likely to have baseline mMEPs. mMEPs had a sensitivity of 97.4%, specificity of 96.4%, negative predictive value of 98.2% and accuracy of 96.8%.

Conclusions

Baseline mMEPs were obtained in >85% of children ≤2 years of age including those who had motor deficits. TIVA and balanced anesthesia with sevoflurane and ketamine are ideal for mMEP monitoring. mMEPs have a high accuracy although, false positive and false negative results can occasionally be experienced.

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Authors and Affiliations

  1. Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Bijesh R. Nair, Krothapalli Srinivasa Babu & Vedantam Rajshekhar

  2. Department of Neuroanesthesia, Christian Medical College, Vellore, India

    Mariappan Ramamani & Georgene Singh

Authors
  1. Bijesh R. Nair
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  2. Mariappan Ramamani
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  3. Georgene Singh
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  4. Krothapalli Srinivasa Babu
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  5. Vedantam Rajshekhar
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Contributions

The study conception, design and supervision were done by Vedantam Rajshekhar. Material preparation, data collection, and analysis were performed by Bijesh and Krothapalli Srinivasa Babu. The first draft of the manuscript was written by Bijesh, Mariappan Ramamani and Georgene Singh. Manuscript was reviewed and edited by Krothapalli Srinivasa Babu and Vedantam Rajshekhar. All authors read and approved the final manuscript.

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Correspondence to Vedantam Rajshekhar.

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Nair, B.R., Ramamani, M., Singh, G. et al. Feasibility and diagnostic accuracy of intra-operative monitoring of motor evoked potentials in children <2 years of age undergoing tethered cord surgery: results in 100 children. Childs Nerv Syst 37, 2289–2298 (2021). https://doi.org/10.1007/s00381-021-05128-5

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