ASSESSMENT OF SPINAL CORD INTEGRITY DURING SURGICAL CORRECTION OF SCOLIOSIS USING SEVOFLURANE VERSUS REMIFENTANIL, PROPOFOL BASED ANESTHESIA

Abstract

The risk of paraplegia from orthopedic surgery of the spine. Therefore spinal cord function monitoring is mandatory. The aim of this study was to compare the effects of sevoflurane/Nitrous oxide i.e. inhalational anesthesia (2 groups containing 12 patients each) versus remifentanil/Propofol i.e. total intravenous anesthesia TIVA (2 groups containing 12 patients each) on the latency and amplitude of the wave of somatosensory evoked potential (SEP) and their suitability for the application of the "Wake up" test during surgical correction of scoliosis in children. lnhalational anesthetics (sevoflurane and nitrous oxide) decreased the amplitude statistically significant from the awake reading (from 1.23±0.48).tV to 0.61±0.20)lV; P=0.00015). Statistically significant decrease in the amplitude (from 1.23±0.47)lV to 0.88±0.35)lV; P=O.OOl) started to be observed after a loading dose of remifentanil and persisted throughout the surgical procedure without statistically significant changes in the subsequent readings. TIVA with propofol 6-1Omg!kglhr + remifentanil 0.25)lg!kg/min + atracurium was shown to be the anesthetic technique of choice, when SEP monitoring is needed. In spite of latency prolongation, the amplitude preservation (28.5% decrease from the

awake value) was in favor of early prediction of morphological wave changes. On the other hand, this was not the case with inhalation anesthesia as the marked decrease of the amplitude (50.4% from the awake) was on the expense of the morphology of the wave rendering its early detection much difficult.