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Anaesthesia and multimodality intraoperative neuromonitoring in carotid endarterectomy. Chronological evolution and effects on intraoperative neurophysiology

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Abstract

Contingency data was retrospectively collected to evaluate the historical and current ability to provide multimodality intraoperative neurophysiological monitoring during carotid endarterectomy under two conditions: total intravenous anaesthesia (TIVA) and low dose halogenated anaesthesia (SEVO). 229 patients were monitored during carotid endarterectomy procedures under general anaesthesia between 2012 and 2020. 121 Patients were monitored with SEVO at a minimum alveolar concentration less than 0.7 and 108 were monitored using TIVA, according to common anaesthetic practice standards in our hospital across the years. Multimodality IONM was established with electroencephalography, somatosensory evoked potentials and motor evoked potentials. As compared to TIVA, patients monitored with SEVO showed significantly higher motor evoked potential thresholds (313.52 ± 77.74 SEVO and 218.93 V ± 103.2 V TIVA p < 0.05) and lower reproducibility. Electroencephalography and somatosensory evoked potentials showed no significant differences among the groups. When using SEVO, multimodality intraoperative neurophysiological monitoring during carotid endarterectomy could mask or miss a motor isolated change in patients in spite of low dose minimum alveolar concentration and of apparently adequate electroencephalography and somatosensory evoked potentials for monitoring. Given these difficulties, we believe the chronological transfer to TIVA could have improved our ability to establish multimodality intraoperative neurophysiological monitoring during carotid endarterectomy in recent times.

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Authors and Affiliations

  1. Queen´S Hospital, Barking, Havering and Redbridge University Trust NHS, Romford, UK

    Ana Mirallave Pescador

  2. Unidad de Monitorización Neurofisiológica Intraoperatoria, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España

    Pedro Javier Pérez Lorensu & Ángel Saponaro González

  3. Servicio de Anestesia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España

    Beneharo Darias Delbey

  4. Servicio de Cirugía Vascular, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España

    José Luis Pérez Burkhardt, Roberto Ucelay Gómez, Enrique Francisco González Tabares, Zeina Ibrahim Achi, Christian Salvador Guerrero Ramírez & Carol Elizabeth Padrón Encalada

  5. Unidad de Investigación, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España

    Alejandro Jiménez Sosa

  6. Servicio de Neurocirugía, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España

    Julio Plata Bello

Authors
  1. Ana Mirallave Pescador
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  2. Pedro Javier Pérez Lorensu
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Contributions

AMP, PPL and ASG prepared the manuscript, elaborated statistical analysis and prepared figures and tables. They also carried out the monitoring. BDD is the attending anesthesiologist and also prepared the manuscript. JPB, RUG, EGT, ZIA, CGR, CPE are the vascular surgeons and prepared the manuscript. AJS, JPB helped with statistical analysis and prepared the manuscript.

Corresponding author

Correspondence to Ana Mirallave Pescador.

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None of the authors have any conflict of interest.

Ethical approval

This study was approved by the ethics committee at Hospital Universitario de Canarias with the code 2017_76 as a retrospective study.

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Mirallave Pescador, A., Pérez Lorensu, P.J., Saponaro González, Á. et al. Anaesthesia and multimodality intraoperative neuromonitoring in carotid endarterectomy. Chronological evolution and effects on intraoperative neurophysiology. J Clin Monit Comput 35, 1429–1436 (2021). https://doi.org/10.1007/s10877-020-00621-9

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  • DOI: https://doi.org/10.1007/s10877-020-00621-9

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