En cirugía de columna vertebral, la vigilancia neurofi siológica mediante potenciales evocados motores (PEMs), es una necesidad innegable. La presencia de relajación muscular farmacológica difi culta al neurofi siólogo esta tarea en relación directa a su intensidad, ya que estando el paciente bajo relajación completa es imposible el registro de los PEMs. El cirujano, en contraste, necesita la mejor relajación muscular posible. Objetivo: Encontrar el umbral en donde el paciente tenga el mayor grado de relajación muscular posible y que permita la adquisición confi able de PEMs. Material y métodos: Se realizó un estudio observacional, analítico, prospectivo y longitudinal en 19 pacientes no obesos, entre los 27 y 60 años (47.26 ± 10 años) a quienes, bajo anestesia total endovenosa y vecuronio como relajante muscular administrado en dosis única, se cuantifi có la profundidad de la relajación muscular con tren de cuatro (TOF), cada dos minutos hasta que el neurofi siólogo obtuvo una respuesta confi able. Resultados: El promedio de TOF para una respuesta adecuada fue de 15.63 ± 3.253% a los 32.95 ± 5.632 minutos. Conclusiones: En los pacientes no obesos, se obtuvo una relajación muscular medida por TOF de alrededor de 15% y es posible obtener un registro de PEMs confi able.

/pdf/nivel-adecuado-de-relajacion-muscular-y-potenciales-evocados-pux8s2jsmy.pdf

Nivel adecuado de relajación muscular y potenciales evocados motores confiables en cirugía de columna lumbar

Objective To study the effect of the degree of muscle relaxation on motor-evoked potential elicited by transcranial electrical stimulation in patients undergoing spine surgery. Methods Sixty ASA I or II patients undergoing spine surgery were randomly divided into 5 groups (n=12). After an initial intubation, continuous cisatracurium infusion was administered with continuous monitoring of T1. The infusion dose was adjusted according muscle relaxation monitoring, and different muscle relaxation degrees were maintained in the 5 groups. The band and latency of D1 in motor-evoked potential was observed with also subjective assessment of the muscle relaxation. Results Significant differences in the band and latency were noted in groups I and II compared with the reference values, but not in groups III, IV and V. Subjective assessment revealed significant differences between groups IV and V and groups I and III in terms of the number of cases with poor muscle relaxation. Conclusion T1 value between 10% and 15% is sufficient for MEP monitoring and allows the maintenance of good muscle relaxation during spine surgery.

[Effect of the degree of muscle relaxation on motor-evoked potential elicited by transcranial electrical stimulation in spine surgery].

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[Effect of the degree of muscle relaxation on motor-evoked potential elicited by transcranial electrical stimulation in spine surgery].