各种麻醉方案对接受脊髓手术的婴儿运动唤起潜力的影响:一系列案例
Hirofumi Nakahari1,2, Makoto Ikeda2, Niall C T Wilton3
1Department of Anesthesia, St. Luke's International Hospital, Tokyo, Japan.
麻醉选择影响婴儿运动唤起潜力 (MEP) 监测. 添加sevoflurane到基于propofol的麻醉剂降低了MEP信号质量,而单独的静脉内全麻醉则改善了脊柱手术的质量.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 神经生理学 神经生理学
- 脊柱外科手术 脊柱外科手术
背景情况:
- 运动唤起潜力 (MEP) 监测对于儿科脊柱手术至关重要.
- 由于信号幅度较小,婴儿的MEP监测存在挑战.
- 关于麻醉对婴儿MEP监测的影响的数据有限.
研究的目的:
- 评估不同麻醉方案对MEP监测婴儿 (<1岁) 成功的影响.
- 为了比较在全静脉麻醉 (TIVA) 下的MEP监测结果与使用sevoflurane的TIVA.
主要方法:
- 19名接受脊柱手术的婴儿与MEP监测的回顾性病例系列 (2022年2月 - 2023年7月).
- 在三种麻醉方案中分析MEP幅度 (没有,响应,可接受,足够).
- 对TIVA的propofol/remifentanil,TIVA与低剂量sevoflurane之间的成功监测率的比较,以及从组合到单独的TIVA的转换.
主要成果:
- 提瓦的普罗波/雷米芬坦尼尔的成功率为62.5%.
- 在TIVA中添加低剂量席沃兰,成功率降至25%.
- 从联合麻醉转换为单独的TIVA显著增加了成功率,从47.9%增加到84.4%.
结论:
- 添加到基于的TIVA的低剂量赛沃兰抑制了婴儿的MEP幅度.
- 在这个人群中,单独的静脉内全麻醉似乎对MEP监测更有效.
- 需要进一步的研究来确定婴儿MEP监测的最佳麻醉策略.
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