British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Transcranial magnetic-evoked potentials under total intravenous anaesthesia and nitrous oxide.
Magnetic stimulation of the cortex and recording of the motor-evoked potentials (MEPs) by electromyography (EMG) is a well proven method to assess the descending pathways of the spinal cord and detect neurological impairment. We have assessed, in 33 adult patients undergoing spinal surgery, the influence of four total i.v. anaesthesia regimens (TIVA) on this recording technique. In 20 patients, the effect of 50% nitrous oxide was also studied. ⋯ Propofol (in combination with alfentanil or ketamine) showed marked depression of the MEP amplitude and the lowest success rates of stimulation. The latencies did not change at all. The addition of nitrous oxide significantly depressed the registered MEPs and lowered the success rates.
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Anaesthesia systems that minimize the use of volatile anaesthetics to reduce cost and pollution are of interest. Closed circuit anaesthesia is the ideal solution, but requires continuous adjustment of fresh gas flow and composition and thus is demanding in routine practice. We describe an alternative system, the Reflector system, which is open in regard to oxygen, nitrogen and N2O, and semiclosed in regard to volatile anaesthetics. ⋯ Isoflurane consumption using the Reflector system in bench tests and an animal study was compared with that of an open system. In bench tests consumption was reduced by 79% and 82%, at a respiratory frequency of 10 and 20 min-1, respectively. The corresponding mean figures from the animal experiment were 65% and 77%.