Episode 103: Neuromonitoring with Drs. Ritzl and Russo

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 103: Neuromonitoring with Drs. Ritzl and Russo

In this 103rd episode I welcome Dr. Eva Ritzl and Dr. Alyson Russo to the show to discuss intraoperative neuromonitoring.

CME: https://earnc.me/k8DsYq

Reference: Solt K and Froman S. Correlating the clinical actions and molecular mechanisms of general anesthetics. Curr Op in Anaes. 2007:20(4);300-306.

3 thoughts on “Episode 103: Neuromonitoring with Drs. Ritzl and Russo”

  1. No mention of dexmedetomidine as an adjunct to the typical propofol-remi TIVA combo. Any thoughts or opinions from you or the presenters on the role, if any, for this drug.

    1. Hi JK,

      Good question. Here is Dr. Russo’s response:

      Dexmedetomidine does not appear to have much in the way of adverse effects on MEPs or SSEPs (on either latency or amplitude). As an adjunct, it may help to decrease the amount of propofol needed to maintain anesthesia when doing a TIVA anesthetic, but I don’t know how clinically relevant this is yet. In addition, dexmedetomidine does have analgesic benefits through its alpha-2 adrenergic agonist effects, and could decrease the amount of opioids required both intraoperatively and into the immediate post-operative period if used as an adjunct in neurosurgical procedures.

      Here are a few recent papers to take a look at:
      Li Y, Meng L, Peng Y, et al. Effects of Dexmedetomidine on motor- and somatosensory-evoked potentials in patients with thoracic spinal cord tumor: a randomized controlled trial. BMC Anesthesiol. 2016;16(1):51. Published 2016 Aug 2. doi:10.1186/s12871-016-0217-y

      Batra A, Verma R, Bhatia VK, Chandra G, Bhushan S. Dexmedetomidine as an Anesthetic Adjuvant in Intracranial Surgery. Anesth Essays Res. 2017;11(2):309-313.

  2. I agree that Dexmedetomidine can be used without significant effects on neuromonitoring as in the study by Li et al. where they used 0.5 mcg/kg dose over 10 minutes.
    But I found this study which shows that significant effects (50% decrease) on MEP can occur ~ 1 mcg/kg of Dexmedetomidine ( which correlate with 0.8 ng/ml plasma levels).

    Anesthesiology. 2010 Jun;112(6):1364-73. doi: 10.1097/ALN.0b013e3181d74f55.

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