AI Article Synopsis

  • The study aimed to compare the effects of different anesthetics on two types of motor evoked potentials: transcranial (TcMEPs) and transesophageal (TeMEPs).
  • The experiment involved anesthetizing pigs and measuring the responses of TcMEPs and TeMEPs at varying concentrations of desflurane and doses of propofol.
  • The results showed that TeMEPs had significantly larger amplitudes than TcMEPs, indicating that TeMEPs are more resistant to anesthetic effects, making them a potentially better option for monitoring during surgery.

Article Abstract

Purpose: Intraoperative neurologic monitoring can be useful, but transcranial motor evoked potentials (TcMEPs) are sensitive to anesthetic agents. We compared the effects of anesthetics on the newly developed transesophageal motor evoked potentials (TeMEPs) with those on TcMEPs.

Methods: Eleven pigs (25.6 ± 0.8 kg) were anesthetized by desflurane inhalation, remifentanil was maintained at 0.5 µg/kg/min until the end of the experiment. End-tidal desflurane concentration was then maintained at 7, 4, 10, and 13%, and TcMEPs and TeMEPs were measured at each concentration. Desflurane was then discontinued and propofol was infused at 10, 20, 40, and 60 mg/kg/h, and TcMEPs and TeMEPs were measured at each infusion dose. An electroencephalogram monitor was used to measure the hypnotic level.

Results: Both desflurane and propofol anesthesia decreased bispectral index in a dose-dependent manner (P < 0.0001), replicating shallow (or adequate) to deep hypnotic levels in both anesthetic methods. The amplitude of TeMEPs was clearly larger than that of TcMEPs and was significantly larger at all anesthetic depths and all limb sites (P < 0.0001). Amplitudes of the lower extremities were lower than those of the upper extremities (P < 0.0001) for both TcMEPs and TeMEPs, but the amplitudes of TeMEPs were sufficiently large under desflurane as under propofol. The trend of concentration-dependent decrease in the amplitudes of TeMEPs under both anesthetics was not as apparent as in that of TcMEPs.

Conclusions: TeMEPs are more tolerant to anesthesia than TcMEPs and may be a promising MEP monitoring technique for the lower corticospinal tract.

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http://dx.doi.org/10.1007/s00540-024-03443-0DOI Listing

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