title: Transcranial motor evoked potentials during anesthesia with desflurane versus propofol--A prospective randomized trial.
abstract: OBJECTIVE
  This study aimed to evaluate differences in transcranial electrical motor evoked potential (tcMEP) amplitudes between desflurane/remifentanil and propofol/remifentanil anesthesia treatment plans in patients without preexisting motor deficits (PMDs) undergoing carotid endarterectomy (CEA).
  
  
  METHODS
  This prospective trial included 21 patients who were randomly assigned to an effect group (Group(DESFLURANE); n=14) or a control group (Group(STANDARD-PROPOFOL); n=7). tcMEP amplitudes were measured 35 min post-induction (T1) either with desflurane or propofol. Treatment was then changed to propofol in Group(DESFLURANE). After an additional 35 min, the tcMEP amplitudes were reevaluated (T2). Differences in amplitudes (DW) between T1 and T2 were calculated for each patient, and the means of these differences were compared between groups.
  
  
  RESULTS
  tcMEPs were recorded in all 21 patients. At T1, the mean amplitude was 840.1 (SD 50.3) μV and 358.9 (SD 74) μV for Group(STANDARD-PROPOFOL) and Group(DESFLURANE), respectively. The absolute mean difference (T1-T2) between groups was -496.75 μV (p=0.0006).
  
  
  CONCLUSIONS
  Desflurane reduces the tcMEP amplitude significantly more than propofol in patients without PMDs undergoing CEA.
  
  
  CONCLUSIONS
  TcMEPs were recorded in all patients regardless of the anesthesia regimen. In patients with initially small amplitudes, desflurane may limit tcMEP recording because it produces a remarkable amplitude reduction, even in patients without PMDs.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany. Electronic address: mmalcharek@me.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Malcharek
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Loeffler
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Schiefer
authors.affiliation: Division of Biostatistics at Computational Landscape Ecology & Community Ecology, Helmholtz-Centre for Environmental Research GmbH - UFZ, Leipzig, Germany.
authors.forename: M A
authors.initials: MA
authors.lastname: Manceur
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Sablotzki
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gille
authors.affiliation: Department of Anesthesiology, Witten/Herdecke University, Helios Clinic Wuppertal, Nordrhein-Westfalen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Pilge
authors.affiliation: Department of Anesthesiology, Witten/Herdecke University, Helios Clinic Wuppertal, Nordrhein-Westfalen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000077335:Desflurane; D019054:Evoked Potentials, Motor / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D015742:Propofol / Q000008:administration & dosage*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol
keywords: Desflurane; Intraoperative neurophysiologic monitoring; Motor evoked potentials; Propofol; Total intravenous anesthesia; Volatile anesthetics