PDF(Pubmed)
Abstract：
Motor-evoked potential (MEP) monitoring is commonly used in children. MEP monitoring in infants is difficult due to smaller signals requiring higher stimulation voltages. There is limited information on the effect of different anesthetics on MEP monitoring in this age group. This case series describes the effect of different anesthetic regimens on MEP monitoring in infants. Patients <1 year of age who underwent spinal surgery with MEP monitoring between February 2022 and July 2023 at a single tertiary care children hospital were reviewed. The motor-evoked potential amplitudes were classified into 4 levels based on the voltage in the upper and lower limbs (none, responded, acceptable, sufficient). \"Acceptable\" or \"sufficient\" levels were defined as successful monitoring. A total of 19 infants were identified, involving 3 anesthesia regimens: 4/19 (21.1%) cases were anesthetized with propofol/remifentanil total intravenous anesthesia (TIVA), 3/19 (15.8%) with propofol/remifentanil/low-dose sevoflurane and another 12/19 (63.2%) cases who initially received propofol/remifentanil/sevoflurane and were converted to propofol/remifentanil anesthesia intraoperatively. The 4 cases with propofol/remifentanil showed 20/32 (62.5%) successful monitoring points. In contrast, 6/24 (25%) successful points were achieved with propofol/remifentanil intravenous anesthesia/0.5 age-adjusted minimum alveolar concentration sevoflurane. In 12 cases converted from propofol/remifentanil/low-dose inhalational anesthetics to TIVA alone, successful MEP monitoring points increased from 46/96 (47.9%) to 81/96 (84.4%). Adding low-dose inhalation anesthetic to propofol-based TIVA suppresses MEP amplitudes in infants. The optimal anesthetic regimen for infants requires further investigation.
摘要：
运动诱发电位（MEP）监测通常用于儿童。由于较小的信号需要较高的刺激电压,婴儿中的MEP监测是困难的。关于该年龄组不同麻醉药对MEP监测的影响的信息有限。本病例系列描述了不同麻醉方案对婴儿MEP监测的影响。对2022年2月至2023年7月在一家三级护理儿童医院接受MEP监测的脊柱手术<1岁的患者进行了审查。根据上肢和下肢的电压，将运动诱发电位幅度分为4个级别（无，回应,可接受,足够）。“可接受”或“足够”级别被定义为成功监控。共有19名婴儿被确认,涉及3种麻醉方案:4/19(21.1%)例采用丙泊酚/瑞芬太尼全静脉麻醉(TIVA),3/19（15.8％）使用丙泊酚/瑞芬太尼/低剂量七氟醚，另外12/19（63.2％）例最初接受丙泊酚/瑞芬太尼/七氟醚麻醉并在术中转换为丙泊酚/瑞芬太尼麻醉。4例丙泊酚/瑞芬太尼成功监测20/32(62.5%)。相比之下,丙泊酚/瑞芬太尼静脉麻醉/0.5年龄调整的最低肺泡浓度七氟醚达到6/24（25％）成功点。在12例由丙泊酚/瑞芬太尼/低剂量吸入麻醉药转换为单独TIVA的病例中，成功的MEP监测点从46/96(47.9%)增加到81/96(84.4%).在基于丙泊酚的TIVA中添加低剂量吸入麻醉药可抑制婴儿的MEP振幅。婴儿的最佳麻醉方案需要进一步研究。
