地氟醚和七氟醚對神經外科手術中軀體感覺誘發電位和運動誘發電位監測效果的影響:一項隨機對照試驗

地氟醚和七氟醚均對SEPs和MEPs有劑量依賴性抑製作用。

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地氟醚和七氟醚對神經外科手術中軀體感覺誘發電位和運動誘發電位監測效果的影響:一項隨機對照試驗


貴州醫科大學 麻醉與心臟電生理課題組

翻譯:張中偉  編輯:張中偉  審校:曹瑩



 
背景

      感覺誘發電位(SEP)和運動誘發電位(MEP)監測技術的使用為神經外科手術提供了更好的保護。然而,一些研究表明吸入鹵化麻醉藥對神經生理監測的效果有顯著影響。



 
方法

       40名連續接受神經外科手術的患者被隨機分為兩組,分別接受地氟醚和七氟醚吸入麻醉。以最小肺泡濃度(MAC)為標準在多個水準(0.3、0.6和0.9)進行給藥,然後記錄SEPs和MEPs的潛伏期時長和波幅。




 
結果

       在接受神經外科手術的患者中,採用濃度為0.3、0.6和0.9 MAC的地氟醚或七氟醚作為全身麻醉中的吸入麻醉藥,SEP和MEP信號保存良好。隨著MAC的增加,SEPs和MEPs的波幅降低,SEPs潛伏期延長(P < 0.05)。地氟醚組上肢和下肢SEP潛伏期均顯著長于七氟醚組,SEP波幅顯著低於七氟醚組(P < 0.05)。地氟醚組MEP波幅明顯低於七氟醚組(P < 0.05),僅上肢在0.3 MAC時波幅無明顯變化。




 
結論

      地氟醚和七氟醚均對SEPs和MEPs有劑量依賴性抑製作用。在相同MAC下,地氟醚的抑製作用強于七氟醚。因本研究中所有患者的神經檢查結果均正常,所以項結論可能不適用於既往存在缺陷的患者。



 
原始文獻來源

           Xiang Bingbing, Jiao Shulan, Zhang Yulong, et al. Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked potential monitoring during neurosurgery: a randomized controlled trial.[J]. BMC Anesthesiol(2021) 21:240 : 1.



Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked

potential monitoring during neurosurgery: a randomized controlled trial

Abstract

Background: Better protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring.


Method:A total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded.


Results:SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or

sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly.


Conclusion:SEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients

studied had normal neurological examination findings, hence, these results may not be applicable to patients with

preexisting deficits.



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