Fecha de la publicación: 03/01/2021
Autor: Ana Mirallave Pescador (1), Pedro Javier Pérez Lorensu (2), Ángel Saponaro González (2), Beneharo Darias Delbey (3), José Luis Pérez Burkhardt (4), Roberto Ucelay Gómez (4), Enrique Francisco González Tabares (4), Zeina Ibrahim Achi (4), Christian Salvador Guerrero Ramírez (4), Carol Elizabeth Padrón Encalada (4), Alejandro Jiménez Sosa (5), Julio Plata Bello (6)
1Queen´S Hospital, Barking, Havering and Redbridge University Trust NHS, Romford, UK. A.firstname.lastname@example.org.
2Unidad de Monitorización Neurofisiológica Intraoperatoria, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
3Servicio de Anestesia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
4Servicio de Cirugía Vascular, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
5Unidad de Investigación, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
6Servicio de Neurocirugía, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
Contingency data was retrospectively collected to evaluate the historical and current ability to provide multimodality intraoperative neurophysiological monitoring during carotid endarterectomy under two conditions: total intravenous anaesthesia (TIVA) and low dose halogenated anaesthesia (SEVO). 229 patients were monitored during carotid endarterectomy procedures under general anaesthesia between 2012 and 2020. 121 Patients were monitored with SEVO at a minimum alveolar concentration less than 0.7 and 108 were monitored using TIVA, according to common anaesthetic practice standards in our hospital across the years. Multimodality IONM was established with electroencephalography, somatosensory evoked potentials and motor evoked potentials. As compared to TIVA, patients monitored with SEVO showed significantly higher motor evoked potential thresholds (313.52 ± 77.74 SEVO and 218.93 V ± 103.2 V TIVA p < 0.05) and lower reproducibility. Electroencephalography and somatosensory evoked potentials showed no significant differences among the groups. When using SEVO, multimodality intraoperative neurophysiological monitoring during carotid endarterectomy could mask or miss a motor isolated change in patients in spite of low dose minimum alveolar concentration and of apparently adequate electroencephalography and somatosensory evoked potentials for monitoring. Given these difficulties, we believe the chronological transfer to TIVA could have improved our ability to establish multimodality intraoperative neurophysiological monitoring during carotid endarterectomy in recent times.