Comparative Evaluation of the Effects of Two Methods of Anesthesia Management on Outcome of Wake-Up Test during Constructive Spinal Column Surgery

Document Type : Original Article(s)

Authors

1 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medicine Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medicine Sciences, Isfahan, Iran

Abstract

Background: Wake-up test is one of the diagnostic tests for preventing permanent and severe damages during reconstruction surgeries of spinal columns. In this study, application of haloperidol and propofol were compared in improving speed and quality of this test.Methods: In a clinical trial study, 42 candidates of scoliosis reconstruction surgeries were randomly divided in 2 groups. In case group, intravenous haloperidol (0.1 mg/kg), 50% nitrous oxide in oxygen plus atracurium (1.5 mg/kg), and fentanyl (1 µg/kg q 30 minutes) were used for maintenance of anesthesia; and in control group, propofol (0.6 mg/kg/hour), remifentanil 0.15 (µg/kg/hour), and atracurium 0.15 (mg/kg q 30 minutes) were prescribed. Two groups were compared in quality and speed of wake-up test and some hemodynamic and respiratory indices.Findings: Patients in case and control groups had statistical differences in mean arterial pressure (79.73 ± 2.60 and 81.36 ± 2.60 mmHg, respectively, P= 0.029), heart rate (88.26 ± 3.90 and 92.78 ± 5.20, respectively, P = 0.040) and SpO2 (P < 0.001). In haloperidol and propofol groups, the mean of wake-up time in wake-up tests was 2.38 ± 0.66 and 11.52 ± 2.44 minutes, respectively (P < 0.001), and the mean extubation time was 296.40 ± 153.71 and 393.33 ± 319.18 seconds, respectively (P < 0.001).Conclusion: Application of haloperidol for maintenance of anesthesia in scoliosis reconstruction surgeries has better quality and faster waking time in comparison to propofol while preserving suitable hemodynamic and respiratory parameters.

Keywords


  1. Jahangiri FR, Sayegh SA, Azzubi M, Alrajhi AM, Annaim MM, Al Sharif SA, et al. Benefit of intraoperative neurophysiological monitoring in a pediatric patient with spinal dysmorphism, split cord malformation, and scoliosis. Neurodiagn J 2017; 57(4): 295-307.
  2. Cognetti D, Keeny HM, Samdani AF, Pahys JM, Hanson DS, Blanke K, et al. Neuromuscular scoliosis complication rates from 2004 to 2015: A report from the Scoliosis Research Society Morbidity and Mortality database. Neurosurg Focus 2017; 43(4): E10.
  3. Miller RD, Eriksson L, Fleisher F, Wiener-Kronish J, Cohen N, Young W. Miller's anesthesia. 8th ed. Philadelphia, PA: Saunders; 2015. vol 2. p. 2404.
  4. Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: Results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 1995; 96(1): 6-11.
  5. Eggspuehler A, Sutter MA, Grob D, Jeszenszky D, Dvorak J. Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients. Eur Spine J 2007; 16 Suppl 2: S188-S196.
  6. Davis SF, Altstadt T, Flores R, Kaye A, Oremus G. Report of seizure following intraoperative monitoring of transcranial motor evoked potentials. Ochsner J 2013; 13(4): 558-60.
  7. Davis SF, Kalarickal P, Strickland T. A report of two cases of lip and tongue bite injury associated with transcranial motor evoked potentials. Am J Electroneurodiagnostic Technol 2010; 50(4): 313-20.
  8. MacDonald DB. Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 2002; 19(5): 416-29.
  9. Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res 1973; (93): 173-8.
  10. Teng WN, Tsou MY, Chen PT, Liou JY, Yu L, Westenskow DR, et al. A desflurane and fentanyl dosing regimen for wake-up testing during scoliosis surgery: Implications for the time-course of emergence from anesthesia. J Formos Med Assoc 2017; 116(8): 606-12.
  11. Fung NY, Hu Y, Irwin MG, Chow BE, Yuen MY. Comparison between sevoflurane/remifentanil and propofol/remifentanil anaesthesia in providing conditions for somatosensory evoked potential monitoring during scoliosis corrective surgery. Anaesth Intensive Care 2008; 36(6): 779-85.
  12. Saponaro GA, Perez Lorensu PJ, Chaves GS, Nodarse Medina JF, Torres Dios JA. What Can We Learn From Two Consecutive Cases? Droperidol May Abolish TcMEPs. Turk J Anaesthesiol Reanim 2017; 45(1): 53-5.
  13. Gomez-Arnau JI. Droperidol and cardiac arrhythmias. Rev Esp Anestesiol Reanim 2003; 50(5): 221-4. [In Spanish].
  14. Misal US, Joshi SA, Shaikh MM. Delayed recovery from anesthesia: A postgraduate educational review. Anesth Essays Res 2016; 10(2): 164-72.
  15. Han CS, Kim YK. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics 2004; 45(4): 297-301.
  16. Franco-Bronson K, Gajwani P. Hypotension associated with intravenous haloperidol and imipenem. J Clin Psychopharmacol 1999; 19(5): 480-1.
  17. Canbay O, Altiparmak B, Celebi N, Karagoz H, Saricaoglu F. Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial. Braz J Anesthesiol 2015; 65(6): 470-5.
  18. Zhang CH, Ma WQ, Yang YL, Dong FT, Wang HM, Wei HM. Effect of the intraoperative wake-up test in sevoflurane-sufentanil combined anesthesia during adolescent idiopathic scoliosis surgery: A randomized study. J Clin Anesth 2013; 25(4): 263-7.
  19. Pinsky MR. Applied cardiovascular physiology in theatre: measuring the cardiovascular effects of propofol anaesthesia. Br J Anaesth 2016; 116(6): 736-8.