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Anaesthesia for MEP use intraoperatively

This case report discusses the anesthesia management of a 27-year-old male undergoing spinal tumor excision for a C7-T1 intramedullary tumor. Utilizing motor-evoked potentials (MEPs) through transcranial electrical stimulation, various anesthetic agents were evaluated for their impact. The protocol included intubation, prone positioning, and thorough monitoring to prevent complications. The findings highlight the effectiveness of ketamine-based anesthesia with propofol supplementation to minimize psychotropic effects while ensuring optimal intraoperative monitoring of MEPs.

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Anaesthesia for MEP use intraoperatively

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  1. Anaesthesia for MEP use intraoperatively R3 鄭淳心

  2. Case: A 27y/o male was a case of C7-T1 intramedullary spinal tumor, and he was scheduled for spinal tumor excision via posterior approach. Transcranial stimulation motor evoked potentials was used intraoperatively. Past history: nothing particular

  3. Spinal surgery: • Intubation • Prone position • Monitor • Free from pressure: eyes, nose, ear, genitalia • Endo fixation

  4. EP (Evoked potentials) • SSEP(somatosensory evoked potentials ) • Wake-up test • Motor evoked potentials • (false positive results)

  5. Evoked potentials • Anesthetics • Temperature • Hypotension • Hypoxia • Anemia • Pre-existing neurological lesions

  6. Temperature • EMG response decrease • 8.0%/C muscle • 4.1%/C skin • no correlation • keep the same temperature

  7. Anesthetic agents • Inhalation agents • IV-agents Propofol Etomidate Methohexital Thiopental • Ketamine-based anesthesia • With or without propofol

  8. Propofol inhibits motor-evoked potentials induced by transcranial electrical stimulation in a dose- dependent manner • If a train of pulses is used for transcranial stimulation, propofol can be effectively used as a supplement to ketamine- based anesthesia during intraoperative monitoring of myogenic motor-evoked potentials • Addiction of propofol significantly reduced the ketamine-induced psychedelic effect including unpleasant dreaming and hallucination.

  9. Formula 1 • Ketamine 1-2 mg/kg/hr • Fentanyl • 50% nitrous oxide in oxygen • Vecuronium 0.04 mg/kg/hr • Propofol 1-3 mg/kg/hr • Nicardipine if SBP>150mmHg

  10. Formula 2 (’96 BJA) • Methohexitone 2mg/kg for hypnosis 0.1mg/kg/min for 30 min 3-4.5 mg/kg/hr • Alfentanil 50 ug/kg 300ug/kg/hr for 15min 60ug/kg/hr • Ketamine 1.2 mg/kg/hr for 1hour 0.84 mg/kg/hr • muscle relaxant bolus

  11. our formula • Ketamine 2mg/kg/hr • Alfentanil 20ug/kg/hr • Esmeron 6mg/hr • Propofol 75mg/hr (1.5mg/kg/hr)

  12. Maintain anesthesia depth (microsurgery) • BP control: nicardipine

  13. Thank you for your attention!!

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