Concomitant using bulbocavernosus reflex and motor-evoked potential from the external anal sphincter improves
Chinami Tone1, Yuki Ogawa2, Hironobu Hayashi1
1Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Insights
Combining bulbocavernosus reflex (BCR) and external anal sphincter motor-evoked potential (EAS-MEP) monitoring improves intraoperative assessment of urinary function in pediatric patients undergoing untethering surgery.
Area of Science:
- Pediatric Urology
- Neurophysiology
- Surgical Monitoring
Background:
- Intraoperative monitoring is crucial for preventing postoperative urinary dysfunction during surgery.
- Preoperative neurological dysfunction and young age present challenges for effective monitoring in pediatric patients.
Purpose of the Study:
- To evaluate the combined efficacy of bulbocavernosus reflex (BCR) and external anal sphincter motor-evoked potential (EAS-MEP) monitoring.
- To assess urinary function in pediatric patients undergoing untethering surgery.
Main Methods:
- Retrospective analysis of pediatric patients (<6 years) undergoing untethering surgery.
- Simultaneous BCR and EAS-MEP monitoring was performed.
- Anesthesia maintained without neuromuscular blockade using propofol or sevoflurane/opioid.
Main Results:
- Combined BCR and EAS-MEP monitoring achieved a 89% success rate.
- Individual BCR and EAS-MEP success rates were 78% and 61%, respectively.
- Monitoring accurately identified patients with new or worsened urinary dysfunction, correlating with catheterization needs.
Conclusions:
- BCR and EAS-MEP monitoring demonstrate similar accuracy in pediatric untethering surgery.
- Concomitant use of BCR and EAS-MEP enhances continuous intraoperative monitoring compared to single-method use.
Purpose:
Intraoperative monitoring can be used to prevent postoperative urinary dysfunction due to surgical manipulation. However, preoperative neurological dysfunction and young age make monitoring challenging. Therefore, in this study, we evaluated the efficacy of combining two monitoring methods, the bulbocavernosus reflex (BCR) and motor-evoked potential from the external anal sphincter (EAS-MEP) in assessing urinary function in the same pediatric patients during untethering surgery.
Methods:
We retrospectively identified pediatric patients (aged < 6 years) who underwent BCR and EAS-MEP monitoring during untethering surgery between October 2013 and March 2022. Anesthesia was maintained using propofol or sevoflurane/opioid without neuromuscular blockade.
Results:
We identified 18 pediatric patients who underwent BCR and EAS-MEP monitoring during untethering surgery. Our results showed that the baseline success rates were 78%, 61%, and 89% for BCR, EAS-MEP, and the concomitant use of BCR and EAS-MEP, respectively. Furthermore, of the 18 pediatric patients, the two patients with new urinary dysfunction required postoperative urinary catheterization, and the three patients with worsened preoperative urinary dysfunction showed an increased frequency of catheterization. The accuracy of the BCR and EAS-MEP monitoring for the same patients was 93% and 91%, respectively.
Conclusion:
The accuracy of BCR and EAS-MEP monitoring is similar in pediatric untethering surgery, and the concomitant use of BCR and EAS-MEP improves continuous intraoperative monitoring compared with using only one method.
