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2015, Number 1

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Rev Mex Anest 2015; 38 (1)

Adequate level of muscle relaxation and reliable evoked motor potentials in lumbar spine surgery

Suárez-Morales M, Mendoza-Popoca CU, Soto-Navarro MA, Shkurovich-Bialik P, Rodríguez-Reyes J, Revilla-Pacheco FR, Herrada-Pineda T

Language: Spanish
References: 17
Page: 21-26
PDF size: 482.35 Kb.


ABSTRACT

Neurophysiological monitoring during spinal surgery using motor evoked potentials (MEPs) is essential. This task can be challenging when deep muscular relaxation is used during the procedure, since MEPs are sensitive to neuromuscular blocking agents. The surgeon, on the other hand, usually requires profound muscular relaxation for an adequate approach of the surgical field. Objectives: To determine the threshold of reliable MEPs when neuromuscular blocking agents are used during total intravenous anesthesia and vecuronium. Material and methods: A longitudinal, prospective, analytic open study, including 19 non-obese patients aged 27 to 60 (47.26 ± 10) years old referred for decompressive spinal surgery was performed. Using total intravenous anesthesia and vecuronium as muscle relaxant, single dose to facilitate orotracheal intubation, whose profundity was assessed through the train of four tests (TOF), every two minutes until the clinical neurophysiological team found reliable MEPs. Results: MEPs were observed with an average TOF of 15.63 ± 3.253%, and the time when these responses were obtained was 32.95 ± 5.632 minutes. Conclusions: MEPs can be reliably obtained in non-obese patients during spinal procedures with TOF of 15%, when total intravenous anesthesia and vecuronium is used.


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