Indian Journal of Anaesthesia

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 63  |  Issue : 2  |  Page : 92--99

The effects of propofol and isoflurane on intraoperative motor evoked potentials during spinal cord tumour removal surgery - A prospective randomised trial


Parthiban Velayutham1, Verghese T Cherian2, Vedantam Rajshekhar3, Krothapalli S Babu3 
1 Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Sector-22, Kharghar, Navi Mumbai, Maharashtra, India
2 Department of Anaesthesiology, Penn State College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, H187, Hershey, PA, USA, USA
3 Department of Neurological Sciences, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Parthiban Velayutham
Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Sector-22, Kharghar, Navi Mumbai - 410 210, Maharashtra
India

Background and Aims: Transcranial electrical stimulation (TES) elicited intraoperative motor evoked potentials (iMEPs), are suppressed by most anaesthetic agents. This prospective randomised study was carried out to compare the effects of Isoflurane and Propofol on iMEPs during surgery for spinal cord tumours. Methods: A total of 110 patients were randomly divided into two groups. In group P, anaesthesia was maintained with intravenous propofol (6.6 ± 1.5 mg/kg/hr) and in group I anaesthesia was maintained with isoflurane (0.8 ± 0.1% minimal alveolar concentration (MAC). An Oxygen- air mixture (FiO2-0.3) was used in both groups. TES-iMEPs were recorded from tibialis anterior, quadriceps, soleus and external anal sphincter muscles in 60 of 90 patients. Statistical analysis was performed with Pearson correlation and Paired 't' tests. Results: Successful baseline iMEPs were recorded in 74% of patients in Group P and in 50% of patients in Group I. Age and duration of symptoms influenced the elicitation of baseline iMEPs under isoflurane (r = −0.71, −0.66 respectively, P < 0.01) as compared to propofol (r = −0.60, −0.50 respectively, P < 0.01). The mean stimulus strength required to elicit the baseline iMEPs were lesser in propofol (205 ± 55Volts) as compared to isoflurane (274 ± 60 Volts). Suppression of the iMEP responses was less under propofol (7.3%) as compared to isoflurane anaesthesia (11.3%) in patients with no preoperative neurological deficits. Conclusion: iMEPs are better maintained under propofol anaesthesia (6-8 mg/kg/hr) when compared with isoflurane (0.7-0.9 MAC). in patients undergoing surgery for excision of spinal cord tumours.


How to cite this article:
Velayutham P, Cherian VT, Rajshekhar V, Babu KS. The effects of propofol and isoflurane on intraoperative motor evoked potentials during spinal cord tumour removal surgery - A prospective randomised trial.Indian J Anaesth 2019;63:92-99


How to cite this URL:
Velayutham P, Cherian VT, Rajshekhar V, Babu KS. The effects of propofol and isoflurane on intraoperative motor evoked potentials during spinal cord tumour removal surgery - A prospective randomised trial. Indian J Anaesth [serial online] 2019 [cited 2019 Aug 17 ];63:92-99
Available from: http://www.ijaweb.org/article.asp?issn=0019-5049;year=2019;volume=63;issue=2;spage=92;epage=99;aulast=Velayutham;type=0