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What Can We Learn From Two Consecutive Cases? Droperidol May Abolish TcMEPs
Ángel Saponaro González1, Pedro Javier Pérez Lorensu1, Santiago Chaves Gómez2
1Intraoperative Neurophysiologic Monitoring Unit, University Hospital Of Canarias, Santa Cruz De Tenerife, Spain.
Turkish Journal of Anaesthesiology and Reanimation
|April 6, 2017
Summary
Droperidol administration can temporarily abolish transcranial motor evoked potentials (TcMEPs) during spine surgery. Adjusting stimulation parameters to a double train of pulses can restore monitorable TcMEPs, bypassing the drug's central effects.
Area of Science:
- Anesthesiology
- Neurophysiology
- Spine Surgery
Background:
- Droperidol, a D2 antagonist, is used for postoperative nausea and vomiting prophylaxis.
- A 2001 FDA black box warning limited droperidol use due to cardiovascular risks.
- No prior literature documented droperidol's effect on transcranial motor evoked potentials (TcMEPs).
Observation:
- Two spine surgery cases (pediatric scoliosis, adult spinal metastasis) utilized intraoperative neurophysiological monitoring (IONM).
- IONM included TcMEPs and somatosensory evoked potentials (SEPs).
- Temporal loss of TcMEPs, without SEPs changes, occurred after droperidol administration.
Findings:
- Droperidol administration temporarily abolished TcMEPs in both patients.
- Modifying TcMEP stimulation to a double train of pulses elicited responses.
- TcMEPs returned to baseline levels within five minutes post-administration.
Implications:
- Droperidol prophylaxis for postoperative nausea can abolish TcMEPs.
- Altering stimulation parameters can overcome droperidol's central inhibitory effect on TcMEPs.
- This technique allows for continued reliable intraoperative monitoring during droperidol use.