Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
Abstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to in...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-11-01
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| Series: | Ain Shams Journal of Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42077-021-00190-2 |
| _version_ | 1818651729131995136 |
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| author | Neha Amey Panse Jyoti Vishnu Kale Tejaswini Lalasaheb Phalke Utkarsha Pradeep Bhojane |
| author_facet | Neha Amey Panse Jyoti Vishnu Kale Tejaswini Lalasaheb Phalke Utkarsha Pradeep Bhojane |
| author_sort | Neha Amey Panse |
| collection | DOAJ |
| description | Abstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA. |
| first_indexed | 2024-12-17T02:10:44Z |
| format | Article |
| id | doaj.art-ad3acbd9bf4d47f38510f3f929fbc928 |
| institution | Directory Open Access Journal |
| issn | 2090-925X |
| language | English |
| last_indexed | 2024-12-17T02:10:44Z |
| publishDate | 2021-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Ain Shams Journal of Anesthesiology |
| spelling | doaj.art-ad3acbd9bf4d47f38510f3f929fbc9282022-12-21T22:07:34ZengSpringerOpenAin Shams Journal of Anesthesiology2090-925X2021-11-011311710.1186/s42077-021-00190-2Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgeryNeha Amey Panse0Jyoti Vishnu Kale1Tejaswini Lalasaheb Phalke2Utkarsha Pradeep Bhojane3Department of Anaesthesia, Smt. Kashibai Navale Medical CollegeDepartment of Anaesthesia, Smt. Kashibai Navale Medical CollegeDepartment of Anaesthesia, Smt. Kashibai Navale Medical CollegeDepartment of Anaesthesia, Smt. Kashibai Navale Medical CollegeAbstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.https://doi.org/10.1186/s42077-021-00190-2DexmedetomidineFentanylKyphoscoliosisPropofol somatosensory-evoked potential (SSEP)Total intravenous anesthesia (TIVA) |
| spellingShingle | Neha Amey Panse Jyoti Vishnu Kale Tejaswini Lalasaheb Phalke Utkarsha Pradeep Bhojane Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery Ain Shams Journal of Anesthesiology Dexmedetomidine Fentanyl Kyphoscoliosis Propofol somatosensory-evoked potential (SSEP) Total intravenous anesthesia (TIVA) |
| title | Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery |
| title_full | Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery |
| title_fullStr | Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery |
| title_full_unstemmed | Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery |
| title_short | Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery |
| title_sort | dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery |
| topic | Dexmedetomidine Fentanyl Kyphoscoliosis Propofol somatosensory-evoked potential (SSEP) Total intravenous anesthesia (TIVA) |
| url | https://doi.org/10.1186/s42077-021-00190-2 |
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