title: Successful intraoperative spinal cord monitoring during scoliosis surgery using a total intravenous anesthetic regimen including dexmedetomidine.
abstract: Intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is widely used. Because of the possible interference with the recording of evoked potentials by inhalational anesthetics, total intravenous anesthetic (TIVA) regimens have been advocated. TIVA regimens may be difficult to use in pediatric populations due to metabolic factors. We report on the results of multimodality IONM during 18 cases in which a TIVA regimen incorporating dexmedetomidine (Precedex, Hespira, Lake Forest, IL) was used. Monitoring techniques included sensory (SSEP) and motor evoked potentials (MEP), as well as pedicle screw stimulation. SSEPs were maintained within an acceptable range of baseline amplitude (50%) and latency (10%), and MEPs remained elicitable throughout each case. We therefore found that the anesthetic regimen did not significantly interfere with any of the monitoring modalities used and conclude that IONM in the presence of dexmedetomidine is feasible under appropriate conditions.
authors.affiliation: Department of Neurology, Stony Brook University Medical Center, Stony Brook, New York, USA. danschel@yahoo.com
authors.forename: David J
authors.initials: DJ
authors.lastname: Anschel
authors.forename: Andrew
authors.initials: A
authors.lastname: Aherne
authors.forename: Roy G
authors.initials: RG
authors.lastname: Soto
authors.forename: Wesley
authors.initials: W
authors.lastname: Carrion
authors.forename: Carl
authors.initials: C
authors.lastname: Hoegerl
authors.forename: Palgun
authors.initials: P
authors.lastname: Nori
authors.forename: Peggy A
authors.initials: PA
authors.lastname: Seidman
mesh_terms: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000771:Anesthesia, Intravenous; D002648:Child; D020927:Dexmedetomidine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005071:Evoked Potentials / Q000187:drug effects*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D016343:Monitoring, Intraoperative; D019637:Orthopedic Procedures; D015742:Propofol / Q000627:therapeutic use; D012600:Scoliosis / Q000601:surgery*; D013116:Spinal Cord / Q000187:drug effects* / Q000502:physiology
chemical_list: D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D005283:Fentanyl; D015742:Propofol