• Roshan Andleeb, Sanjay Agrawal, and Priyanka Gupta.
• Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, India.
• Asian Spine J. 2021 Aug 20.

Study DesignProspective, randomized, placebo-controlled, double-blind exploratory study.PurposeTo compare effects of dexmedetomidine or a subanesthetic dose of ketamine on the amplitude and latency of transcranial electrically generated motor evoked potentials.Overview Of LiteratureTotal intravenous anesthesia (TIVA) is a standard anesthesia technique for transcranial electrical motor evoked potential monitoring in spine surgery. We aimed to determine whether the use of dexmedetomidine and ketamine as a component of TIVA exerted any beneficial effect on the quality of monitoring.MethodsA total of 90 American Society of Anesthesiologist grade I-III patients, aged 18-65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol-fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation).ResultsBaseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%-100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p <0.05).ConclusionsThe present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.

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