A comparative Evaluation of Dexmedetomidine with Midazolam as An Adjuvant to Propofol Anesthesia for Spinal Surgical Procedures under Motor Evoked Potential Monitoring. | [Anaesthesia, Pain and Intensive Care • 2016]

Author(s):

1. Deepika Aggarwal: Department of Anaesthesiology, Indian Spinal Injuries Centre, New Delhi, India

2. HK Mahajan: Department of Anaesthesiology, Indian Spinal Injuries Centre, New Delhi, India

3. PR Chauhan: Department of Anaesthesiology, Indian Spinal Injuries Centre, New Delhi, India

Abstract:

Background: Intraoperative neurophysiologic monitoring helps to prevent neurologic morbidity from surgical manipulations. Anesthetic agents have a dose dependent adverse effect on the ability to record evoked potential responses. Evoked potentials are highly sensitive to fluctuations in physiological parameters. The main objective of the study was to compare midazolam and dexmedetomidine in producing minimum effect on motor evoked potential amplitude keeping consistent depth of anesthesia and to evaluate hemodynamic stability during the surgery. Methodology: It was a double-blind, randomized control trial. A total of 60 patients, between 10-60 years of age, with ASA class I - II, undergoing spinal surgery under general anesthesia were enrolled and randomly divided into two groups; Group M received midazolam and group D received dexmedetomidine infusion in addition to a standardized anesthesia technique. Motor evoked potential amplitude and heart rate and mean arterial pressure were measured at different intervals in two groups and the results were compared by Chi-square test or Fischer exact test. The significant result was defined as bilateral MEP loss or = 80 % fall in transcranial MEP. [1] For hemodynamic changes = 20% fall from the baseline values was considered as the positive result for both the groups. Results: In Group M 10 (33.3%) patients had fall in motor evoked potential as compred to 2 (6.7%) in Group D (p = 0.010). This difference was found to be statistically significant. Group D showed higher number of patients [7 (23.3%)] with = 20% fall in heart rate as compared to 4 (13.3%) patients in Group M, but this difference was statistically not significant. Fall in mean arterial pressure (>20%) was noted in 9 (30.0%) vs. 2 (6.7%) patients in Group D and M respectively (p = 0.020). The difference was found to be statistically significant. Conclusion: The use of dexmedetomidine is better in terms of minimum effect on motor evoked potentials, but is associated with more adverse effect on hemodynamic parameters as compared to midazolam, when used as an infusion in patients undergoing spinal surgery.

Page(s): 154-158

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 20, Issue: 2, Year: 2016

Keywords:

Keywords are not available for this article.

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