title: Influence of anesthetics--nitrous oxide in particular--on electromyographic response evoked by transcranial electrical stimulation of the cortex.
abstract: The influence of anesthetics usually used for neuroleptic anesthesia--nitrous oxide, fetanyl, flunitrazepam, and thiopental sodium--on motor evoked potentials (MEP) was examined in 15 patients during neurosurgical operations on the spinal cord, in 16 patients in traumatic coma, and in 6 healthy volunteers. MEP were recorded from the contralateral thenar and anterior tibial muscles in response to single transcranial electrical stimuli on the motor cortex. Intraoperatively, during neuroleptic anesthesia we found the amplitudes to be reduced to an average of 11% of the preoperative baselines for the thenar potentials, and to 7% of the preoperative baselines for the anterior tibial muscle potentials, despite a maximum stimulus strength of 750 V. A similar reduction of MEP amplitudes was observed in 6 volunteers during breathing of an oxygen/nitrous oxide mixture (34%/66%), whereas fentanyl, flunitrazepam, and thiopental had only a minor effect on MEP. We conclude that with respect to anesthesia-related suppression of amplitudes, an average of 5 to 15 electromyographic responses should be evaluated for intraoperative monitoring of MEP using the technique described here.
authors.affiliation: Department of Neurosurgery, University of Freiburg, Medical School, Federal Republic of Germany.
authors.forename: J
authors.initials: J
authors.lastname: Zentner
authors.forename: I
authors.initials: I
authors.lastname: Kiss
authors.forename: A
authors.initials: A
authors.lastname: Ebner
mesh_terms: D000328:Adult; D000777:Anesthetics; D004576:Electromyography; D005071:Evoked Potentials / Q000187:drug effects; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009044:Motor Cortex / Q000502:physiology*; D009132:Muscles / Q000294:innervation*; D009493:Neurosurgery; D009609:Nitrous Oxide
chemical_list: D000777:Anesthetics; D009609:Nitrous Oxide