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Muscle-evoked Potentials After Electrical Stimulation to the Brain in Patients Undergoing Spinal Surgery are Less Affected by Anesthetic Fade With Constant-voltage Stimulation Than With Constant-current Stimulation

Tanaka, Masato MD; Shigematsu, Hideki MD, PhD; Kawaguchi, Masahiko MD, PhD; Hayashi, Hironobu MD, PhD; Takatani, Tsunenori MT, PhD; Iwata, Eiichiro MD, PhD; Okuda, Akinori MD, PhD; Morimoto, Yasuhiko MD, PhD; Kawasaki, Sachiko MD; Masuda, Keisuke MD; Yamamoto, Yusuke MD; Tanaka, Yasuhito MD, PhD

doi: 10.1097/BRS.0000000000003166

Study Design. A prospective, within-subject study was conducted.

Objective. We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques.

Summary of Background Data. The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade.

Methods. We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile).

Results. The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time.

Conclusion. The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries.

Level of Evidence: 3

We examined the impact of different stimulation methods (constant-current vs. constant-voltage) on anesthetic fade. The compound muscle action potential waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries.

Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan

Department of Anesthesia, Nara Medical University, Nara, Japan

Division of Central Clinical Laboratory, Nara Medical University, Nara, Japan.

Address correspondence and reprint requests to Hideki Shigematsu, MD, PhD, Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan; E-mail:

Received 24 December, 2018

Revised 7 April, 2019

Accepted 16 May, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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