The use of a circumferential cathode improves amplitude of intraoperative electrical transcranial myogenic motor evoked responses

Anesthesia and Analgesia
L H UbagsJ C Drummond

Abstract

Measurement of motor evoked responses to transcranial electrical stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways. Since most anesthetics significantly reduce motoneuronal excitability, optimal stimulation paradigms should be sought. We compared the efficiency of stimulus delivery using two different configurations of the cathode component of the stimulating electrode pair (circumferential: Fz, F3, F4, A1, and A2 versus a single cathode at Fz). The anode was positioned at Cz with both cathode configurations. Fourteen neurologically normal patients undergoing spinal surgery were anesthetized with sufentanil-N2O-ketamine. Partial neuromuscular blockade (single twitch height 25%) was maintained with vecuronium. Compound action potentials to transcranial stimulation with both cathode configurations were recorded from the tibialis anterior muscle. All recordings were completed before spinal manipulation. The median amplitude response using the Fz cathode configuration was 256 microV (10th-90th percentiles: 50-641 microV). With the circumferential cathode configuration, tc-MER amplitude increased to 281 (87-1479) microV (P < 0.01). There was no significant difference in onset latency between electro...Continue Reading

References

Nov 1, 1989·Electroencephalography and Clinical Neurophysiology·V E AmassianP J Maccabee
Feb 1, 1993·Acta Orthopaedica Scandinavica·C J KalkmanB W Ongerboer de Visser
Apr 1, 1993·Spine·F TabaraudJ Hugont

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Citations

Sep 28, 2012·Journal of Clinical Monitoring and Computing·Tod B Sloan
Sep 24, 2013·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·D B MacdonaldUNKNOWN American Society of Neurophysiological Monitoring
Jan 10, 2002·Anesthesiology Clinics of North America·P de Haan, C J Kalkman
Dec 13, 2002·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·David B MacDonald
Jul 13, 2006·Journal of Clinical Monitoring and Computing·David B Macdonald

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