Updated review on the use of neuromuscular blockade during intraoperative motor-evoked potential monitoring in the modern anesthesia era
Issued Date
2023-01-01
Resource Type
ISSN
09138668
eISSN
14388359
Scopus ID
2-s2.0-85174195891
Pubmed ID
37843561
Journal Title
Journal of Anesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Anesthesia (2023)
Suggested Citation
Phoowanakulchai S., Kawaguchi M. Updated review on the use of neuromuscular blockade during intraoperative motor-evoked potential monitoring in the modern anesthesia era. Journal of Anesthesia (2023). doi:10.1007/s00540-023-03265-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90741
Title
Updated review on the use of neuromuscular blockade during intraoperative motor-evoked potential monitoring in the modern anesthesia era
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Transcranial electrical stimulation motor-evoked potentials (Tc-MEP) monitoring is a common practice in neurosurgery to prevent postoperative neurological damage. However, the use of neuromuscular blocking agents (NMBAs) during Tc-MEP monitoring is a subject of controversy. In addition, the effectiveness of sugammadex, a selective reversal agent, in the context of Tc-MEP monitoring requires further investigation. This review aimed to clarify the considerations involved in achieving optimal Tc-MEP monitoring while ensuring patient safety. Preoperative patient selection, comorbidity assessment, motor power evaluation, and the nature of the planned surgery are critical factors. Accurate paralysis assessment, continuous NMBA infusion, and post-tetanic stimulation techniques are essential for achieving optimal partial NMB. The decision to administer an NMB during Tc-MEP monitoring necessitates a careful evaluation of the balance between accuracy and potential complications. This review emphasizes the challenges associated with NMB administration during Tc-MEP monitoring and highlights the need for personalized patient assessment.