Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery

Abstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to in...

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Autores principales:	Neha Amey Panse, Jyoti Vishnu Kale, Tejaswini Lalasaheb Phalke, Utkarsha Pradeep Bhojane
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Dexmedetomidine Fentanyl Kyphoscoliosis Propofol somatosensory-evoked potential (SSEP) Total intravenous anesthesia (TIVA) Anesthesiology RD78.3-87.3 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/ad3acbd9bf4d47f38510f3f929fbc928
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spelling	oai:doaj.org-article:ad3acbd9bf4d47f38510f3f929fbc9282021-11-07T12:07:50ZDexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery10.1186/s42077-021-00190-22090-925Xhttps://doaj.org/article/ad3acbd9bf4d47f38510f3f929fbc9282021-11-01T00:00:00Zhttps://doi.org/10.1186/s42077-021-00190-2https://doaj.org/toc/2090-925XAbstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.Neha Amey PanseJyoti Vishnu KaleTejaswini Lalasaheb PhalkeUtkarsha Pradeep BhojaneSpringerOpenarticleDexmedetomidineFentanylKyphoscoliosisPropofol somatosensory-evoked potential (SSEP)Total intravenous anesthesia (TIVA)AnesthesiologyRD78.3-87.3Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENAin Shams Journal of Anesthesiology, Vol 13, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Dexmedetomidine Fentanyl Kyphoscoliosis Propofol somatosensory-evoked potential (SSEP) Total intravenous anesthesia (TIVA) Anesthesiology RD78.3-87.3 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Dexmedetomidine Fentanyl Kyphoscoliosis Propofol somatosensory-evoked potential (SSEP) Total intravenous anesthesia (TIVA) Anesthesiology RD78.3-87.3 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Neha Amey Panse Jyoti Vishnu Kale Tejaswini Lalasaheb Phalke Utkarsha Pradeep Bhojane Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
description	Abstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.
format	article
author	Neha Amey Panse Jyoti Vishnu Kale Tejaswini Lalasaheb Phalke Utkarsha Pradeep Bhojane
author_facet	Neha Amey Panse Jyoti Vishnu Kale Tejaswini Lalasaheb Phalke Utkarsha Pradeep Bhojane
author_sort	Neha Amey Panse
title	Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
title_short	Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
title_full	Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
title_fullStr	Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
title_full_unstemmed	Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
title_sort	dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/ad3acbd9bf4d47f38510f3f929fbc928
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Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery

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