Effect of dexmedetomidine-etomidate-fentanyl combined anesthesia on somatosensory- and motor‑evoked potentials in patients undergoing spinal surgery

Lin,Sheng; Dai,Na; Cheng,Zhengyan; Shao,Wei; Fu,Zhijian

doi:10.3892/etm.2014.1555

Effect of dexmedetomidine-etomidate-fentanyl combined anesthesia on somatosensory- and motor‑evoked potentials in patients undergoing spinal surgery

Authors:
- Sheng Lin
- Na Dai
- Zhengyan Cheng
- Wei Shao
- Zhijian Fu
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Affiliations: Department of Anesthesiology, Yantai Shan Hospital, Yantai, Shandong 264001, P.R. China, Public Management Department, Yantai Vocational College, Yantai, Shandong 264001, P.R. China, Department of Anesthesiology, Shandong Provincial Hospital of Shandong University, Jinan, Shandong 250001, P.R. China
Published online on: February 18, 2014 https://doi.org/10.3892/etm.2014.1555
Pages: 1383-1387

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Abstract

This aim of the present study was to evaluate the effects of dexmedetomidine (DEX) on the intraoperative monitoring of somatosensory‑evoked potentials (SEPs) and motor‑evoked potentials (MEPs) in patients undergoing spinal surgery. A total of 36 patients who received spinal surgery under general anesthesia were randomly divided into two groups (n=18 per group), group C, the test group and group D, the control group, and these groups were subjected to a matching anesthesia induction. In brief, the anesthesia was administered via injection of etomidate and fentanyl; once the patients were unconscious, a laryngeal mask airway (LMA) was inserted, SEPs and MEPs were monitored and the collected data were considered to be basic data. Cisatracurium was subsequently injected and an endotracheal tube (7#) was inserted to replace the LMA. The following procedures were conducted for anesthesia maintenance: Group C, the anesthesia was maintained via target‑controlled infusion of etomidate and intermittent injection of fentanyl; and group D, DEX (0.5 µg/kg) was injected over a duration of 10 min and then pumped at a rate of 0.5 µg/kg/h. In the two groups, all of the other drugs used were the same and a muscle relaxant was not administered. The bispectral index was maintained between 45 and 55 during surgery, and the SEPs and MEPs were monitored continuously until the surgery was completed. No significant difference in duration and amplitude of the SEPs (P15‑N20) was identified between group C and D (P>0.05). Furthermore, the MEPs were monitored in the two groups at specific durations and no significant difference was observed between the two groups (P>0.05). The SEPs and MEPs were maintained in the patients who were administered with the DEX‑etomidate‑fentanyl combined anesthesia during spinal surgery.

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1	Schwartz DM, Auerbach JD, Dormans JP, et al: Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am. 89:2440–2449. 2007. View Article : Google Scholar : PubMed/NCBI
2	Hyun SJ and Rhim SC: Combined motor and somatosensory evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in 17 consecutive procedures. Br J Neurosurg. 23:393–400. 2009. View Article : Google Scholar
3	Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP and Young WL: Miller’s Anesthesia. 7th edition. Churchill Livingstone; pp. p10162011
4	Li F, Gorji R, Allott G, Modes K, Lunn R and Yang ZJ: The usefulness of intraoperative neurophysiological monitoring in cervical spine surgery: a retrospective analysis of 200 consecutive patients. J Neurosurg Anesthesiol. 24:185–190. 2012. View Article : Google Scholar
5	Pelosi L, Lamb J, Grevitt M, Mehdian SM, Webb JK and Blumhardt LD: Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol. 113:1082–1091. 2002. View Article : Google Scholar : PubMed/NCBI
6	Taniguchi M, Nadstawek J, Langenbach U, Bremer F and Schramm J: Effects of four intravenous anesthetic agents on motor evoked potentials elicited by magnetic transcranial stimulation. Neurosurgery. 33:407–415. 1993. View Article : Google Scholar : PubMed/NCBI
7	Scheufler KM and Zentner J: Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. Neurosurg. 96:571–579. 2002. View Article : Google Scholar : PubMed/NCBI
8	Ghaly RF, Lee JJ, Ham JH, Stone JL, George S and Raccforte P: Etomidate dose-response on somatosensory and transcranial magnetic induced spinal motor evoked potentials in primates. Neurol Res. 21:714–720. 1999.PubMed/NCBI
9	Menda F, Köner O, Sayin M, Türe H, Imer P and Aykaç B: Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG. Ann Card Anaesth. 13:16–21. 2010. View Article : Google Scholar : PubMed/NCBI
10	Virtanen R, Savola JM, Saano V and Nyman L: Characterisation of the selectivity, specificity and potency of medetomidine as an α2-adrenoceptor agonist. Eur J Pharmacol. 150:9–14. 1988.PubMed/NCBI
11	Hunter JC, Fontana DJ, Hedley LR, et al: Assessment of the role of alpha2-adrenoceptor subtypes in the antinociceptive, sedative and hypothermic action of dexmedetomine in transgenic mice. Br J Pharmacol. 122:1339–1344. 1997. View Article : Google Scholar : PubMed/NCBI
12	Jalonen J, Hynynen M, Kuitunen A, Heikkilä H, Perttilä J, Salmenperä M, Valtonen M, Aantaa R and Kallio A: Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 86:331–345. 1997. View Article : Google Scholar : PubMed/NCBI
13	Wijeysundera DN, Naik JS and Beattie WS: Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 114:742–752. 2003. View Article : Google Scholar
14	Shin HW, Yoo HN, Kim DH, Lee H, Shin HJ and Lee HW: Preanesthetic dexmedetomidine 1 μg/kg single infusion is a simple, easy, and economic adjuvant for general anesthesia. Korean J Anesthesiol. 65:114–120. 2013.
15	Martin E, Ramsay G, Mantz J and Sum-Ping ST: The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med. 18:29–41. 2003. View Article : Google Scholar : PubMed/NCBI
16	Ben-Abraham R, Ogorek D and Weinbroum AA: Dexmedetomidine: a promising agent for anesthesia and perioperative care. Isr Med Assoc J. 2:793–796. 2000.PubMed/NCBI
17	Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A and Otelcioglu S: Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D. 7:43–52. 2006. View Article : Google Scholar
18	Stone LS and Wilcox GL: Alpha-2-adrenergic and opioid receptor additivity in rat locus coeruleus neurons. Neurosci Lett. 361:265–268. 2004. View Article : Google Scholar : PubMed/NCBI
19	Anschel DJ, Aherne A, Soto RG, et al: Successful intraoperative spinal cord monitoring during scoliosis surgery using a total intravenous anesthetic regimen including dexmedetomidine. J Clin Neurophysiol. 25:56–61. 2008. View Article : Google Scholar
20	Tobias JD, Goble TJ, Bates G, Anderson JT and Hoernschemeyer DG: Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescents. Paediatr Anaesth. 18:1082–1088. 2008. View Article : Google Scholar : PubMed/NCBI
21	Bala E, Sessler DI, Nair DR, McLain R, Dalton JE and Farag E: Motor and somatosensory evoked potentials are well maintained in patients given dexmedetomidine during spine surgery. Anesthesiology. 109:417–425. 2008. View Article : Google Scholar : PubMed/NCBI
22	Mahmoud M, Sadhasivam S, Salisbury S, et al: Susceptibility of transcranial electric motor-evoked potentials to varying targeted blood levels of dexmedetomidine during spine surgery. Anesthesiology. 112:1364–1373. 2010. View Article : Google Scholar