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Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia

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Abstract

Transcranial electric motor evoked potentials (TCeMEPs) play an important role in reducing the risk of iatrogenic paraplegia. TCeMEPs could be obviously suppressed by neuromuscular blockade (NMB). The aims of this study were to examine the effects of NMB on TCeMEPs and to determine an appropriate level of partial neuromuscular blockade (pNMB) for TCeMEPs during surgical correction of idiopathic scoliosis under total intravenous anesthesia (TIVA). All patients were maintained with TIVA. The pNMB levels were classified into five phases: one or two train-of-four (TOF) counts (TOF1); three TOF counts, or T4/T1 (TOFR, T1,4, first or four twitch height of TOF) ≤ 15% (TOF2); TOFR at 16–25% (TOF3); TOFR at 26–50% (TOF4); and TOFR at 51–75% (TOF5). No neuromuscular blockade (nNMB) was achieved when TOFR was more than 75%. The absolute and relative latency, amplitude and area under curve (AUC), efficacy of TCeMEPs and rate of unexpected movement were compared among these phases. Neither the amplitude and AUC nor the efficacy of TCeMEPs were affected at TOF4−5 of abductor halluces muscles TCeMEPs (AH-TCeMEPs) or at TOF3−5 of tibialis anterior muscles TCeMEPs (TA-TCeMEPs) compared with nNMB. However, the rate of unexpected movement was increased significantly at TOF5 and nNMB compared with TOF1 and TOF4. The application of pNMB with TOFR aimed at 26–50% for AH-TCeMEPs or 16–50% for TA-TCeMEPs seems to be an appropriate regimen for TCeMEPs during surgical correction for idiopathic scoliosis under TIVA.

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Acknowledgements

The study was funded by the National Natural Science Foundation (81371207), the Key Talent’s of 13th Five-year Plan for Strengthening Health of Jiangsu Province (ZDRCA2016069), the Key Talent’s Project in Medical Science of Jiangsu Province (RC2011006), the Fundamental Research Funds for the Central Universities (0214-14380338), the Natural Science Foundation of Jiangsu Province of China (BK20170654) and the National Natural Science Foundation (81701371). We thank Hua-ye Xu, Jie Chen, Fen Song and Shi-he Cui, who are anesthetists in the department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University. We also thank Jun-yin Qiu, neurologist in the department of Orthopaedic Surgery, Affiliated Drum Tower Hospital of Medical Department of Nanjing University for her invaluable assistance in collecting the data in this study.

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Authors and Affiliations

  1. Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, 321 Zhong Shan Road, Nanjing, Jiangsu, 210008, People’s Republic of China

    Hai-yan Liu, Xing Zhao, Yue Qian, Zheng-liang Ma & Xiao-ping Gu

  2. Medical Department of Nanjing University, Nanjing, People’s Republic of China

    Tian-jiao Xia

  3. Department of Orthopaedic Surgery, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing, People’s Republic of China

    Ze-zhang Zhu

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  1. Hai-yan Liu
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Correspondence to Xiao-ping Gu.

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Liu, Hy., Xia, Tj., Zhu, Zz. et al. Effect of neuromuscular blockade on transcranial electric motor evoked potentials during surgical correction for idiopathic scoliosis under total intravenous anesthesia. J Clin Monit Comput 33, 471–479 (2019). https://doi.org/10.1007/s10877-018-0182-8

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  • DOI: https://doi.org/10.1007/s10877-018-0182-8

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