Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Sharmishtha Pathak; Priyanka Gupta; Ashutosh Kaushal; Konish Biswas

doi:10.1055/s-0043-1772762

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 587-596
DOI: 10.1055/s-0043-1772762

Original Article

Effect of Ketamine and Dexmedetomidine as Adjuvant to Total Intravenous Anesthesia on Intraoperative Cranial Nerve Monitoring in the Patients Undergoing Posterior Fossa Craniotomies—A Randomized Quadruple Blind Placebo-Controlled Study

Sharmishtha Pathak

¹Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India

,

Priyanka Gupta

²Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

,

Ashutosh Kaushal

³Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

,

Konish Biswas

⁴Department of Neuroanaesthesiology and Critical Care, Medanta, Patna, Bihar, India

› Institutsangaben

Abstract

Objectives Total intravenous anesthesia (TIVA) is used during surgery with intraoperative neurophysiological monitoring. Addition of adjuvant may minimize suppression of potentials by reducing doses of propofol. We studied the effect of addition of ketamine or dexmedetomidine to propofol–fentanyl-based TIVA on corticobulbar motor evoked potential (CoMEP) in patients undergoing posterior fossa surgeries.

Materials and Methods Forty-two patients were assigned to three groups (n = 14 each), Group S—saline, Group D—dexmedetomidine (0.25 μg/kg/h), and Group K—ketamine (0.25 mg/kg/h). Patients received propofol and fentanyl infusions along with study drugs. CoMEPs were recorded from muscles innervated by cranial nerves bilaterally at predefined intervals (T_baseline, T₂, T₃, T₄, and T₅). Effect on amplitude and latency of CoMEPs was assessed.

Results A significant fall in CoMEP amplitude was observed across all analyzed muscles at time T₄ and T₅ in saline and dexmedetomidine group as compared with ketamine group, p-value less than 0.05. A significant increase in latency was observed at T4 and T5 among groups (p-value, D vs. K = 0.239, D vs. S = 0.123, and K vs. S = 0.001).

Conclusion Both ketamine and dexmedetomidine provide and allow effective recording of CoMEPs. Ketamine emerges as a better agent especially when prolonged surgical duration is expected as even propofol–fentanyl-based TIVA adversely affects CoMEPs when used for long duration.

Keyword Dexmedetomidine

intraoperative neurophysiological monitoring - motor evoked potential - MEP amplitude - MEP - latency ketamine

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References
1 Broggi G, Scaioli V, Brock S, Dones I. Neurophysiological monitoring of cranial nerves during posterior fossa surgery. Acta Neurochir Suppl (Wien) 1995; 64: 35-39
2 Sala F, Manganotti P, Tramontano V, Bricolo A, Gerosa M. Monitoring of motor pathways during brain stem surgery: what we have achieved and what we still miss?. Neurophysiol Clin 2007; 37 (06) 399-406
3 Bithal P. Anaesthetic considerations for evoked potentials monitoring. J Neuroanaesth Crit Care 2014; 1 (01) 2-12
4 Wang AC, Than KD, Etame AB, La Marca F, Park P. Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature. Neurosurg Focus 2009; 27 (04) E7
5 Kim K, Cho C, Bang MS, Shin HI, Phi JH, Kim SK. Intraoperative neurophysiological monitoring: a review of techniques used for brain tumor surgery in children. J Korean Neurosurg Soc 2018; 61 (03) 363-375
6 van Dongen EP, ter Beek HT, Aarts LP. et al. The effect of two low-dose propofol infusions on the relationship between six-pulse transcranial electrical stimulation and the evoked lower extremity muscle response. Acta Anaesthesiol Scand 2000; 44 (07) 799-803
7 Nathan N, Tabaraud F, Lacroix F. et al. Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth 2003; 91 (04) 493-497
8 Sahinovic MM, Struys MMRF, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet 2018; 57 (12) 1539-1558
9 Liu H, Jian M, Wang C. et al. Effect of sugammadex during transcranial electrical motor evoked potentials monitoring in spinal surgery: a randomized controlled trial. J Neurosurg Anesthesiol 2023; 35 (02) 224-231
10 Andleeb R, Agrawal S, Gupta P. Evaluation of the effect of continuous infusion of dexmedetomidine or a subanesthetic dose ketamine on transcranial electrical motor evoked potentials in adult patients undergoing elective spine surgery under total intravenous anesthesia: a randomized con. Asian Spine J 2022; 16 (02) 221-230
11 Smith V, Maslovat D, Carlsen AN. StartReact effects are dependent on engagement of startle reflex circuits: support for a subcortically mediated initiation pathway. J Neurophysiol 2019; 122 (06) 2541-2547
12 Li J, Gelb AW, Flexman AM, Ji F, Meng L. Definition, evaluation, and management of brain relaxation during craniotomy. Br J Anaesth 2016; 116 (06) 759-769
13 Lam S, Nagata M, Sandhu SK, Veselis RA, McCormick PJ. Effect of ketamine on transcranial motor-evoked potentials during spinal surgery: a pilot study. Br J Anaesth 2019; 123 (06) e530-e532
14 Rozet I, Metzner J, Brown M. et al. Dexmedetomidine does not affect evoked potentials during spine surgery. Anesth Analg 2015; 121 (02) 492-501
15 Li Y, Meng L, Peng Y. et al. Effects of dexmedetomidine on motor- and somatosensory-evoked potentials in patients with thoracic spinal cord tumor: a randomized controlled trial. BMC Anesthesiol 2016; 16 (01) 51
16 Ubags LH, Kalkman CJ, Been HD, Porsius M, Drummond JC. The use of ketamine or etomidate to supplement sufentanil/N2O anesthesia does not disrupt monitoring of myogenic transcranial motor evoked responses. J Neurosurg Anesthesiol 1997; 9 (03) 228-233
17 Sihle-Wissel M, Scholz M, Cunitz G. Transcranial magnetic-evoked potentials under total intravenous anaesthesia and nitrous oxide. Br J Anaesth 2000; 85 (03) 465-467