Comparison of the effects of ketamine-midazolam with those of fentanyl- midazolam on cortical somatosensory evoked potentials during major spine surgery |
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| Authors: | Langeron, O. Lille, F. Zerhouni, O. Orliaguet, G. Saillant, G. Riou, B. Coriat, P. |
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| Affiliation: | Department of Anaesthesiology and Critical Care, Hopital Pitie-Salpetriere, Paris VI University, Paris, France; Department of Neurophysiology, Hopital Pitie-Salpetriere, Paris VI University, Paris, France; Department of Orthopaedic Surgery, Hopital Pitie-Salpetriere, Paris VI University, Paris, France; Department of Anaesthesiology, Hpital Necker, Paris, France |
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| Abstract: | Cortical somatosensory evoked potentials (CSEP) allow monitoring of spinalcord function during surgery. Ketamine has been shown to enhance CSEPamplitude, but there is no previous study comparing its effects with thoseof other anaesthetic regimens. Therefore, we have compared the effects ofketamine with those of fentanyl, both combined with midazolam, on CSEPmonitoring during major spine surgery. Twenty patients with normalpreoperative CSEP were allocated randomly to a ketamine or fentanyl group.Anaesthesia was induced with ketamine 3 mg kg-1 or fentanyl 6 microgramskg-1 i.v., and midazolam 0.3 mg kg-1 i.v in both groups, and maintainedwith continuous i.v infusion of ketamine 2 mg kg-1 h-1 or fentanyl 3micrograms kg-1 h-1, combined in both groups with midazolam 0.15 mg kg-1h-1 and 60% nitrous oxide in oxygen. CSEP were elicited by tibial posteriornerve stimulation and measured P1 and N1 latencies, and P1-N1 amplitude,CSEP were recorded before and after induction, at 15 min, 1 and 2 h afterinduction, during skin closure and after removal of nitrous oxide. Bothgroups were comparable in characteristics, duration of surgery, meanarterial pressure and temperature. CSEP latencies were not significantlyaffected in either group. CSEP amplitude decreased significantly over timein the fentanyl group (from mean 2.02 (SEM 0.41) to 0.95 (0.17) microV, P< 0.05), but not in the ketamine group (from 1.33 (0.36) to 1.05 (0.31)microV, ns). Nevertheless, we did not observe any significant differencesin amplitudes or latencies between the two groups. The delay in obtainingthe first voluntary postoperative motor response was significantly greaterin the ketamine group (170 (54) vs 55 (17) min, P < 0.01). Both ketamineand fentanyl allowed us to obtain reliable CSEP during major spine surgery,and there were no significant difference between these two anaestheticregimens for CSEP monitoring, but a longer delay for voluntarypostoperative motor assessment was observed in the ketamine group. |
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