选择性脊神经后根切断术中背根神经刺激监测的麻醉深度控制

目的 探讨选择性脊神经后根切断术(selective posterior rhizotomy,SPR)中脊髓背根电刺激检查过程中适宜的麻醉深度.方法 选择全麻下接受SPR术的痉挛性脑瘫患者20例,观察术中患者接受脊神经后根电刺激检查过程中,不同麻醉深度(A点:患者BIS＜60;B点:BIS值在60～69;C点:BIS值...

Optimal anesthesia depth for direct dorsal rootlet stimulation during selective posterior rhizotomy

Objective To evaluate optimal anesthesia depth for direct dorsal rootlet stimulation with intraoperative electrophysiological monitoring during selective posterior rhizotomy.Methods Twenty patients with spastic cerebral palsy scheduled for selective posterior rhizotomy were enrolled into the study.All patients received direct dorsal rootlet stimulation with intraoperative electrophysiological monitoring at different anesthesia depth(BIS values under 60 as point A,BIS values between 60 and 69 as point B,BIS values between 70 and 80 as point C,and BIS values over 80 as point D).Electroshock threshold(ST),patients’ hemodynamic values and their response to the stimulations were recorded to evaluate the optimal anesthesia depth.Results ST values at point A were the highest among all the patients.Patients’ hemodynamic values at this point changed remarkably during direct dorsal rootlet stimulation,and ST values must be augmented or reduce the anesthesia depth to finish the intraoperative electrophysiological monitoring.Hemodynamic values at point B and C kept stable during direct dorsal rootlet stimulation,ST values were between 0.2 mA and 0.6 mA,and there was no significant difference at point B and C.Intraoperative electrophysiological monitoring finished successfully without anesthesia depth modulation in these two groups.At point D,patients couldn’t tolerate the direct dorsal rootlet stimulation.Head raising,cough and limb movement were common during the intraoperative electrophysiological monitoring,anesthesia depth must be turned down.Conclusions During intraoperative electrophysiological monitoring,direct dorsal rootlet stimulation may lead to different responses,so proper anesthesia depth is needed to ensure the patients comfort and to avoid the excessive stimulation intensity.For BIS values,the optimal anesthesia depth for direct dorsal rootlet stimulation during selective posterior rhizotomy should be between 60 and 75,but individual differences must be considered.