Clin Neurophysiol. 2015 Jan 29. pii: S1388-2457(15)00059-0. doi: 10.1016/j.clinph.2014.12.030. [Epub ahead of print]
Effects of partial neuromuscular blockade on lateral spread response monitoring during microvascular decompression surgery.
Abstract
OBJECTIVE:
We evaluated the effect of partial neuromuscular blockade (NMB) and no NMB on successful intraoperative monitoring of the lateral spread response (LSR) during microvascular decompression (MVD) surgery.
METHODS:
Patients were randomly allocated into one of three groups: the TOF group, the NMB was targeted to maintain two counts of train-of-four (TOF); the T1 group, maintain the T1/Tc (T1: amplitude of first twitch, Tc: amplitude of baseline twitch) ratio at 50%; and the N group, no relaxants after tracheal intubation. Successful LSR monitoring was defined as effective baseline establishment and maintenance of the LSR until dural opening.
RESULTS:
The success rate of LSR monitoring was significantly lower in the TOF group. But, there was no significant difference between T1 and N. The detection rate of spontaneous free-run electromyography (EMG) activity was significantly higher in the N group compared with the TOF and T1 groups.
CONCLUSIONS:
Partial NMB with a target of T1/Tc ratio at 50% allows good recording of LSR with same outcome as surgery without NMB, and reduced spontaneous EMG activity.
SIGNIFICANCE:
We suggested the availability of partial NMB for intraoperative LSR monitoring.
KEYWORDS:
Electromyography; Facial nerve; Microvascular decompression surgery; Neuromuscular blockade; Neuromuscular monitoring