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ORIGINAL RESEARCH article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1471450
This article is part of the Research Topic Surgical Approaches and Outcomes in Cervical and Thoracic Myelopathies View all articles

The influence of depth of sedation on motor evoked potentials monitoring in youth from 4 to 23 years old: preliminary data from a prospective observational study

Provisionally accepted
Jan Hudec Jan Hudec 1,2Martina Kosinová Martina Kosinová 1,3Tereza Prokopová Tereza Prokopová 1,2*Hana Zelinkova Hana Zelinkova 4Kamil Hudáček Kamil Hudáček 2,5Martin Repko Martin Repko 5,6Roman Gál Roman Gál 2,5Petr Štourač Petr Štourač 1,3
  • 1 Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, South Moravia, Czechia
  • 2 Department of Anesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czechia
  • 3 Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czechia
  • 4 Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, South Moravia, Czechia
  • 5 Faculty of Medicine, Masaryk University, Brno, South Moravia, Czechia
  • 6 Department of Orthopedic Surgery, University Hospital Brno, Brno, Czechia

The final, formatted version of the article will be published soon.

    The influence of various levels of sedation depth on motor evoked potentials (MEP) reproducibility in youth is still unclear because of a lack of data. We tested the hypothesis that a deeper level of total intravenous anesthesia (TIVA) (bispectral index (BIS) 40 ± 5 compared to 60 ± 5) can affect surgeon-directed MEP and their interpretation in youths.Methods: All patients received TIVA combined with propofol and remifentanil. TIVA was initially maintained at a BIS level of 60 ± 5. The sedation anesthesia was deepened to BIS level 40 ± 5 before the skin incision. MEP were recorded and interpreted at both BIS levels. The primary endpoint was to evaluate the effect of the depth of sedation on the MEP reproducibility directed and interpreted by the surgical team in each patient separately. The secondary endpoint was to compare the relativized MEP parameters (amplitude and latency) in percentage at various levels of sedation in each patient separately. We planned to enroll 150 patients. Due to the COVID-19 pandemic, we decided to analyze the results of the first 50 patients.The surgical team successfully recorded and interpreted MEP in all 50 enrolled patients in both levels of sedation depth without any clinical doubts. The MEP parameters at BIS level 40 ± 5, proportionally compared with the baseline, were latency 104% (97% -110%) and the MEP amplitudes 84.5% (51% -109%). Conclusion: Preliminary data predict that deeper sedation (BIS 40 ± 5) does not affect the surgical team's interpretation of MEP in youth patients. These results support that surgeon-directed MEP may be an alternative when neurophysiologists are unavailable.

    Keywords: Bispectral Index, Intraoperative Neurophysiological Monitoring, Motor evoked Potentials, remifentanil, Scoliosis surgery, Total intravenous anesthesia

    Received: 27 Jul 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 Hudec, Kosinová, Prokopová, Zelinkova, Hudáček, Repko, Gál and Štourač. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Tereza Prokopová, Department of Anesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czechia

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