Abstract
Purpose
To investigate whether motor evoked potentials (MEP) to transcranial electrical stimulation under constant blood propofol concentration are affected by the arousing effect of surgical noxious stimuli.
Methods
Twenty patients who underwent elective spinal surgery were studied. Patients were anesthetized with 50% nitrous oxide in oxygen, fentanyl, and propofol to maintain the bispectral index (BIS) score around 50. MEP in response to a multipulse transcranial electrical stimulation at stimulus sites of C3–C4 were recorded over the right abductor pollicis brevis muscle. Changes of peak-to-peak amplitude and onset latency of MEP, BIS score before and after surgical stimuli were evaluated. Propofol plasma concentration was measured at the same time points.
Results
Both MEP amplitude and latency did not change significantly after surgical stimuli although BIS increased significantly (48 ±6 to 58 ± 5;P < 0.05). Plasma propofol concentration was maintained at the same level between the two measurement points (3.3 ± 0.7 to 3.3 ± 0.7 μg·mL−1). There was no relation between BIS change and changes of MEP amplitude and latency, and propofol plasma concentration.
Conclusion
MEP to the transcranial electrical stimulation under a constant and clinically appropriate blood propofol concentration are not affected by surgical noxious stimuli.
Résumé
Objectif
Découvrir si les potentiels évoqués moteurs (PEM) obtenus par une stimulation électrique transcrânienne, pendant le maintien d’une concentration sanguine constante de propofol, sont influencés par l’activation des stimuli chirurgicaux douloureux.
Méthode
Vingt patients qui devaient subir une opération non urgente de la colonne vertébrale ont été étudiés. Ils ont reçu une anesthésie réalisée avec un mélange de protoxyde d’azote et d’oxygène à 50 %, du fentanyl et du propofol pour maintenir la valeur de l’index bispectral (BIS) autour de 50. Les PEM obtenus par une stimulation électrique transcrânienne multi-impulsionnelle aux sites de C3–C4 ont été enregistrés sur le muscle court abducteur du pouce. Les changements d’amplitude crête-à-crête et le temps de latence des PEM ainsi que le score du BIS avant et après les stimuli chirurgicaux ont été évalués. La concentration plasmatique de propofol a été mesurée aux mêmes moments.
Résultats
L’amplitude et la latence des PEM n’ont pas changé de façon significative après les stimuli chirurgicaux, même si le BIS a augmenté significativement (48 ± 6 à 58 ± 5;P < 0,05). La concentration plasmatique de propofol a été maintenue au même niveau entre les deux points de mesure (3,3 ± 0,7 à 3,3 ± 0,7 μg·mL-1). Il n’y avait pas de relation entre les changements du BIS et ceux de l’amplitude et de la latence des PEM, et la concentration plasmatique de propofol.
Conclusion
Les PEM obtenus par stimulation électrique transcrânienne, pendant le maintien d’une concentration sanguine de propofol appropriée à la situation clinique, ne sont pas influencés par les stimuli chirurgicaux douloureux.
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Financial support: this work was supported by Grant-in Aid for Scientific Research C2-10671439, Ministry of Education, Tokyo, Japan.
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Inoue, S., Kawaguchi, M., Takahashi, M. et al. Noxious stimuli do not modify myogenic motor evoked potentials by electrical stimulation during anesthesia with propofol-based anesthesia. Can J Anesth 50, 86–91 (2003). https://doi.org/10.1007/BF03020194
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DOI: https://doi.org/10.1007/BF03020194