Brain Surgery Clinical Trial
Official title:
Predictive Factors of Unpredicted Movement in Motor Evoked Potential During Intraoperative Neurophysiologic Monitoring in Adult Patients Undergoing Brain Surgery.
The purpose of this study was to identify the predictive factors of unpredicted movement in motor evoked potential (MEP) during intraoperative neurophysiologic monitoring in adult patients undergoing brain surgery.
Despite advances in neuroendovascular techniques, several complications can occur by brain
urgery. Therefore, for neurosurgeons and anesthesiologists, it is a major concern to describe
and monitor surgical lesion for maintaining structural and functional integrity as well as
achieving maximal cytoreduction in lesion, and modifying the management of patients on the
process of surgery. For example, microvascular Doppler sonography, indocyanine green
aniography, intraoperative digital subtraction angiography, and intraoperative
neurophysiologic monitoring (IONM) are used for this purpose.
The incidence of unpredictable and unacceptable movement is relative low. However, the
results are so horrendous that they can cause injuries in site of rigid pin fixation of the
head, cervical spine injuries, excessive surgical field movement, and deterioration of
surgical outcome. However, risk factors associated with unpredictable and unacceptable
movement remain unclear. Therefore, the aim of this retrospective study was to evaluate risk
factors associated with unpredictable and unacceptable movement in the patients who underwent
brain surgery with MEP monitoring under general anesthesia while using neuromuscular blocking
agent.
The investigators recorded demographic data including age in years, sex, height in meters,
weight in kilograms, body mass index (BMI in kg/m^2), ASA physical status class, diagnosed
disease, performed surgical procedure, duration of anesthesia in minutes, duration of surgery
in minutes, underlying disease (e.g. hypertension, diabetes, neurologic disease, respiratory
disease), medications. Laboratory data was also collected including arterial blood gas
analysis, hematocrit, hemoglobin, sodium, potassium, ionized calcium, ionized magnesium, and
lactate. Unpredictable and unacceptable movement was defined as either the dangerous gross
movement requiring the increase the continuous infusion rate of rocuronium in view of the
surgeon, anesthesiologist, and neurophysiologic specialist or the shake of the surgical field
requiring the increase the continuous infusion rate of rocuronium.
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