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Updated review on the use of neuromuscular blockade during intraoperative motor-evoked potential monitoring in the modern anesthesia era

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Abstract

Transcranial electrical stimulation motor-evoked potentials (Tc-MEP) monitoring is a common practice in neurosurgery to prevent postoperative neurological damage. However, the use of neuromuscular blocking agents (NMBAs) during Tc-MEP monitoring is a subject of controversy. In addition, the effectiveness of sugammadex, a selective reversal agent, in the context of Tc-MEP monitoring requires further investigation. This review aimed to clarify the considerations involved in achieving optimal Tc-MEP monitoring while ensuring patient safety. Preoperative patient selection, comorbidity assessment, motor power evaluation, and the nature of the planned surgery are critical factors. Accurate paralysis assessment, continuous NMBA infusion, and post-tetanic stimulation techniques are essential for achieving optimal partial NMB. The decision to administer an NMB during Tc-MEP monitoring necessitates a careful evaluation of the balance between accuracy and potential complications. This review emphasizes the challenges associated with NMB administration during Tc-MEP monitoring and highlights the need for personalized patient assessment.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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  1. Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Sirima Phoowanakulchai

  2. Department of Anesthesiology, Nara Medical University, Shijo 840, Kashihara, Nara, 634-8522, Japan

    Sirima Phoowanakulchai & Masahiko Kawaguchi

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  1. Sirima Phoowanakulchai
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SP: performed the literature search, organized the data, and drafted the manuscript. MK who had the idea for the articles responsible for the integrity of the work from conception to the critically revised and final approval of the article. All authors read and approved the final manuscript.

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Correspondence to Masahiko Kawaguchi.

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Phoowanakulchai, S., Kawaguchi, M. Updated review on the use of neuromuscular blockade during intraoperative motor-evoked potential monitoring in the modern anesthesia era. J Anesth 38, 114–124 (2024). https://doi.org/10.1007/s00540-023-03265-6

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