Motor-evoked potential facilitation during progressive cortical suppression by propofol

Anesthesia and Analgesia
Kai-Michael Scheufler, Josef Zentner

Abstract

We characterized the effects of various stimulation patterns on motor-evoked potentials (MEPs) elicited by repetitive transcranial magnetoelectric stimulation at different levels of cortical suppression by propofol. In 20 patients undergoing lumbar disk surgery, propofol target plasma concentrations (PTPCs) were increased incrementally by target plasma-level controlled infusion during the induction of anesthesia. MEPs were recorded from the muscles of the upper extremities after single, double, and quadruple magnetoelectric stimulation at 500, 200, and 100 Hz. The mean PTPC during loss of responsiveness to verbal instructions (CP50) was 3 microg/mL (CP(95), 5 microg/mL). At PTPCs <3 microg/mL, maximal MEP amplitudes were elicited by quadruple stimulation at 100 Hz. At PTPCs > or =3 microg/mL, four pulses at 200 Hz yielded peak MEP amplitudes. Therefore, quadruple magnetoelectric stimulation at 100 Hz yields peak myogenic responses in awake patients. With progressive cortical suppression resulting from PTPCs beyond 3 microg/mL, the most effective stimulation frequency shifts to 200 Hz. This may be explained by a differential dose-dependent action of propofol on GABAergic cortical interneurons, corresponding to the clinically obs...Continue Reading

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Citations

Nov 19, 2002·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Babak Boroojerdi
Mar 27, 2003·Current Opinion in Critical Care·Harvey L EdmondsChristopher B Shields
Sep 29, 2020·Journal of Intensive Care Medicine·Lauren K BuhlM Dustin Boone
Dec 17, 2003·Journal of Neurosurgical Anesthesiology·Michelle L LottoArmin Schubert
Aug 30, 2017·Frontiers in Neural Circuits·Zhen-Yu WuYun-Qing Li
May 4, 2004·Annales Françaises D'anesthèsie Et De Rèanimation·A M DebailleulR Krivosic-Horber

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