Effect of Low-dose Lidocaine on Motor Evoked Potentials in Patients Undergoing Intracranial Tumor Resection With Propofol Anesthesia

2021 ◽  
Author(s):  
Meijuan Liu ◽  
Ning Wang ◽  
Dong Wang ◽  
Juan Liu ◽  
Wenjie Jin
Keyword(s):  
Adverse Events ◽  
Evoked Potentials ◽  
Low Dose ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Intracranial Tumor ◽  
Anesthesia Induction ◽  
Total Dosage ◽  
Lidocaine Group ◽  
Significant Difference

Abstract ObjectTo investigate the effect of low-dose lidocaine on motor evoked potentials (MEP) in patients undergoing intracranial tumor resection with propofol anesthesia.MethodsForty patients undergoing intracranial tumor resection and required MEP monitoring were selected.They were randomly divided into the lidocaine group (Group L, n=20) and control group (Group C, n=20) by computer generated randomization. All patients were given propofol anesthesia under the guidance of bispectral index (BIS).In Group L, lidocaine 1 mg/kg was injected intravenously during anesthesia induction. Then, lidocaine was continuously pumped at the speed of 1 mg/kg·h until the operation start. Group C was given the equal volume of normal saline. Heart rate (HR), mean artery pressure (MAP), and BIS were recorded before anesthesia induction (T0), 2 min after tracheal intubation (T1), 35 min (T2) and 50 min (T3) after anesthesia induction. The amplitude and latency of MEP at T2 and T3, the total dosage of propofol, and adverse events before T3 were recorded.ResultsCompared with Group C, HR and MAP were significantly decreased at T1 in Group L. No significant difference was observed in HR and MAP at T0, T2 and T3 between Group L and Group C. The total dosage of propofol and the incidence of adverse events were significantly lower in Group L than in Group C before T3. There was no significant difference in the amplitude and latency of MEP between the two groups at each time point.ConclusionLow-dose lidocaine has no effect on MEP in patients undergoing intracranial tumor resection. In addition, it increased hemodynamic stability, reduced propofol use, and decreased the incidence of adverse events.

scholarly journals A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway

2016 ◽  
Vol 125 (4) ◽  
pp. 795-802 ◽  
Author(s):  
Tammam Abboud ◽  
Miriam Schaper ◽  
Lasse Dührsen ◽  
Cindy Schwarz ◽  
Nils Ole Schmidt ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Threshold Level ◽  
Neurological Deterioration ◽  
Motor Deficit ◽  
Percentage Increase ◽  
Glioma Surgery ◽  
Leg Muscles ◽  
Threshold Criterion

OBJECTIVE Warning criteria for monitoring of motor evoked potentials (MEP) after direct cortical stimulation during surgery for supratentorial tumors have been well described. However, little is known about the value of MEP after transcranial electrical stimulation (TES) in predicting postoperative motor deficit when monitoring threshold level. The authors aimed to evaluate the feasibility and value of this method in glioma surgery by using a new approach for interpreting changes in threshold level involving contra- and ipsilateral MEP. METHODS Between November 2013 and December 2014, 93 patients underwent TES-MEP monitoring during resection of gliomas located close to central motor pathways but not involving the primary motor cortex. The MEP were elicited by transcranial repetitive anodal train stimulation. Bilateral MEP were continuously evaluated to assess percentage increase of threshold level (minimum voltage needed to evoke a stable motor response from each of the muscles being monitored) from the baseline set before dural opening. An increase in threshold level on the contralateral side (facial, arm, or leg muscles contralateral to the affected hemisphere) of more than 20% beyond the percentage increase on the ipsilateral side (facial, arm, or leg muscles ipsilateral to the affected hemisphere) was considered a significant alteration. Recorded alterations were subsequently correlated with postoperative neurological deterioration and MRI findings. RESULTS TES-MEP could be elicited in all patients, including those with recurrent glioma (31 patients) and preoperative paresis (20 patients). Five of 73 patients without preoperative paresis showed a significant increase in threshold level, and all of them developed new paresis postoperatively (transient in 4 patients and permanent in 1 patient). Eight of 20 patients with preoperative paresis showed a significant increase in threshold level, and all of them developed postoperative neurological deterioration (transient in 4 patients and permanent in 4 patients). In 80 patients no significant change in threshold level was detected, and none of them showed postoperative neurological deterioration. The specificity and sensitivity in this series were estimated at 100%. Postoperative MRI revealed gross-total tumor resection in 56 of 82 patients (68%) in whom complete tumor resection was attainable; territorial ischemia was detected in 4 patients. CONCLUSIONS The novel threshold criterion has made TES-MEP a useful method for predicting postoperative motor deficit in patients who undergo glioma surgery, and has been feasible in patients with preoperative paresis as well as in patients with recurrent glioma. Including contra- and ipsilateral changes in threshold level has led to a high sensitivity and specificity.

scholarly journals Lidocaine versus magnesium sulfate infusion during isoflurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial

2021 ◽  
Keyword(s):  
Brain Tumor ◽  
Magnesium Sulfate ◽  
Bispectral Index ◽  
Muscle Relaxant ◽  
Minimum Alveolar Concentration ◽  
Tumor Resection ◽  
Loading Dose ◽  
Depth Of Anesthesia ◽  
Lidocaine Group ◽  
Significant Difference

Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications. Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane. Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00). Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.

scholarly journals Efficacy of low dose pirfenidone in idiopathic pulmonary fibrosis: real world experience from a tertiary university hospital

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Myung Jin Song ◽  
Sung Woo Moon ◽  
Ji Soo Choi ◽  
Sang Hoon Lee ◽  
Su Hwan Lee ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Adverse Events ◽  
Dose Reduction ◽  
Dose Group ◽  
Low Dose ◽  
High Dose Group ◽  
High Dose ◽  
Significant Difference

AbstractPirfenidone is an antifibrotic agent that has been proven to slow down the progression of idiopathic pulmonary fibrosis (IPF). The aim of this study was to evaluate the efficacy of low-dose pirfenidone (that is, less than 1200 mg/day). We retrospectively reviewed the medical records of patients with IPF. The patients were divided into the following three groups, those who were not treated with pirfenidone (control) and those who were treated with pirfenidone at doses < 1200 mg/day (low-dose group) and ≥ 1200 mg/day (high-dose group). The adjusted mean changes in forced vital capacity (FVC) in 1 year were − 200.7, − 88.4, and − 94.7 mL in the control, low-dose, and high-dose groups (p = 0.021). The FVC declined more significantly in the control group than in the low-dose and high-dose groups. No significant difference in FVC change was observed between the low-dose and high-dose groups. Dyspepsia, anorexia, and nausea were significantly more frequent in the low-dose than in the high-dose group, suggesting that dose reduction is attributed to gastrointestinal tract-related adverse events. Dose reduction may help patients to better control gastrointestinal tract-related adverse events; continuing taking the medication at low doses is also expected to be effective in reducing the FVC decline.

Incidence of ischemic complications and technical nuances of arteries protection for insular gliomas resection.

2021 ◽  
Author(s):  
Zonggang Hou ◽  
Zhenxing Huang ◽  
Zhenye Li ◽  
Gen Li ◽  
Yaokai Xu ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Diffusion Weighted Imaging ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Acute Ischemia ◽  
Critical Ischemia ◽  
Diffusion Weighted ◽  
Ischemic Complications

Abstract Insular gliomas remain surgically challenge due to their complex anatomical position and microvascular supply. The incidence of ischemic complications is a risk that should not be ignored. The goal of this study was to analyze the incidence of ischemia and its risk factors, and also describe a single surgeon's arteries protection experience of insular gliomas resection. The authors studied 75 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Analysis included pre- and postoperative demographic, clinical, radiological including diffusion weighted imaging (DWI), as well as intraoperative neurophysiology data, and functional outcomes. Strategies such as “Residual Triangle”, “Basal Ganglia Reconstruction” and “Sculpting Technique” were used to protect lateral lenticulostriate arteries and main branches of M2 for maximal tumor resection according to the different classification of Berger-Sinai. Postoperative diffusion-weighted imaging showed acute ischemia in 44 patients, only 9 of whom developed new motor deficits. Flat inner edge (OR 0.144 95% CI 0.024, 0.876), and motor evoked potentials (MEPs) (<50%) (OR 18.182, 95% CI 3.311, 100.00) were determined to have significant associations with postoperative Critical Ischemia, which located in the posterior limb of the internal capsule or corona radiata. For insular gliomas resection, the protection of main branches of MCA is important. Insular gliomas resection might be with high incidence of ischemia uncovered by DWI which not always result in neurological deficits. Their own strategies maybe the feasible technical nuances allow the surgeon to achieve a thorough and safe resection. Motor evoked potentials is essential for its resection.

Spinal Cord Monitoring

2016 ◽  
pp. 798-832
Author(s):  
Jeffrey A. Strommen ◽  
Andrea J. Boon
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Neurophysiological Monitoring ◽  
Spinal Root ◽  
Compound Muscle Action Potentials ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Intraoperative neurophysiological monitoring is a valuable tool to preserve spinal cord and spinal root integrity during surgical procedures. A monitoring plan may include somatosensory evoked potentials (SEP), motor evoked potentials (MEP), compound muscle action potentials (CMAP), and electromyography (EMG). Such monitoring is individualized depending on the preoperative clinical deficit, the structures most at risk, and the surgical and anesthesia plan. The most common use of these techniques is in primary spine disease, where the spinal cord pathways will typically be monitored with both MEP and SEP. In cervical or lumbar spine surgeries, EMG monitoring will help protect the nerve root either during decompression or during pedicle screw placement. Monitoring during spinal cord tumor resection or vascular procedures (such as aortic aneurysm repair) not only helps prevent deficit, but also allows the surgeon to proceed with confidence and not unnecessarily terminate the procedure.

Low Dose Propofol as a Supplement to Ketamine-Based Anesthesia During Intraoperative Monitoring of Motor-Evoked Potentials

Spine ◽  
2000 ◽  
Vol 25 (8) ◽  
pp. 974-979 ◽  
Author(s):  
Masahiko Kawaguchi ◽  
Takanori Sakamoto ◽  
Satoki Inoue ◽  
Meiko Kakimoto ◽  
Hitoshi Furuya ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Intraoperative Monitoring ◽  
Low Dose ◽  
Motor Evoked Potentials

Electromagnetic Navigation Systems and Intraoperative Neuromonitoring: Reliability and Feasibility Study

2021 ◽  
Vol 20 (4) ◽  
pp. 373-382
Author(s):  
Hannah Keeble ◽  
José Pedro Lavrador ◽  
Noémia Pereira ◽  
Kornelius Lente ◽  
Christian Brogna ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Navigation System ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Motor Deficit ◽  
Neurophysiological Monitoring ◽  
Navigation Systems ◽  
Electromagnetic Navigation ◽  
Significant Difference ◽  
Electromagnetic Navigation System

Abstract BACKGROUND A recent influx of intraoperative technology is being used in neurosurgery, but few reports investigate the accuracy and safety of these technologies when used simultaneously. OBJECTIVE To assess the ability to use an electromagnetic navigation system alongside multimodal intraoperative neurophysiological monitoring (IONM). METHODS Single-institution prospective cohort study of patients requiring craniotomy for brain tumor resection operated using an electromagnetic navigation system (AxiEM, Medtronic®). motor evoked potentials, somatosensory evoked potentials (SSEPs), electroencephalography, and electromyography were recorded and analyzed with AxiEM on (with/without filters) and off. The neurological outcomes of the patients were recorded. RESULTS A total of 15 patients were included (8 males/7 females, mean age 52.13 yr). Even though the raw acquisition is affected by the electromagnetic field (particularly SSEPs), no significant difference was detected in the morphology, amplitude, and latency of the different monitoring modalities (AxiEM off vs on) after the appropriate software filter application. Adjustments to the frequency of SSEP stimulation and number of averages, and reductions to the low-pass filters were applied. Notch filters were used appropriately and changes to the physical setup of the IONM and electromagnetic navigation system equipment reduced noise. Postoperatively, none of the patients developed new focal deficits; 7 patients showed improvement in their motor deficit (4 recovered fully). CONCLUSION The information provided by the IONM in intracranial neurosurgery patients whilst also using electromagnetic navigation systems is reliable for monitoring, mapping, and detecting intraoperative complications, provided that the appropriate software filters and tools are applied.

scholarly journals Perioperative Intravenous Low-Dose Ketamine Infusion to Minimize Pain for Septorhinoplasty: A Prospective, Randomized, Double-Blind Study

2020 ◽  
pp. 014556132097486
Author(s):  
Irem Ates ◽  
Muhammed Enes Aydin ◽  
Erkan Cem Celik ◽  
Mustafa Sitki Gozeler ◽  
Ali Ahiskalioglu
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Blind Study ◽  
Control Group ◽  
Anesthesia Induction ◽  
Double Blind Study ◽  
Double Blind ◽  
Ketamine Infusion ◽  
Pain Scores ◽  
Significant Difference

Objectives: Studies investigating the effects of intravenous (IV) ketamine in pain management after septorhinoplasty is limited. This study aims to evaluate the efficacy of low-dose IV infusion of ketamine on pain scores. Methods: This randomized, prospective, double-blind study was conducted with 48 patients who underwent septorhinoplasty. Intravenous ketamine bolus (0.5 mg/kg) was administered to the ketamine group (group K, n = 24) at anesthesia induction, and ketamine infusion was continued (0.25 mg/kg/h) during the surgery. In the control group (group C, n = 24), the same protocol was administered using saline instead of ketamine. Furthermore, 50-mg dexketoprofen trometamol was administered to both groups 30 minutes before the end of the surgery. Then it was repeated at the 12th and 24th hours postoperatively. Pain scores were evaluated with the visual analogue scale. Consumptions intraoperative of opioid and sevoflurane, rescue opioid requirement, patient satisfaction, and side effects were recorded. Results: Pain scores were significantly lower in group K at all postoperative periods ( P < .05). There was no significant difference between the groups in terms of intraoperative sevoflurane and remifentanil consumptions ( P > .05). Rescue opioid analgesic requirements were significantly lower in group K than group C (0/24 vs 6/24, respectively; P  = .022). Side effects were similar between the groups ( P > .05). Conclusion: We recommend the administration of low-dose ketamine infusion during septorhinoplasty surgery because it reduces the requirement for rescue opioid analgesia and postoperative pain scores.

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