Visual Evoked Potentials
Conditions
Brief summary
Intraoperative flash visual evoked potentials (FVEPs) can be used to monitor the integrity of the visual pathway in real-time during surgeries, and is to prevent the damage and deterioration of visual function caused by visual pathway damage, which is the key method of intraoperative monitoring of visual function. Spinal surgery in the prone position may compress the eyeball and reduce the blood supply of the ophthalmic artery, which is still one of the main causes of postoperative visual impairment. Intraoperative FVEPs monitoring is easily affected by inhale anesthetics, and there is little studies on the effect of intravenous-inhalation balanced anesthesia on FVEPs monitoring. Desflurane wakes up quickly, which is conducive to the recovery of early respiratory function and orientation, and early neurological evaluation. This study aims to compare the effects of desflurane-propofol balanced anesthesia and desflurane pure inhalation anesthesia on the amplitude and latency of FVEPs during spinal surgery under the same sedation depth monitored by bispectral index (BIS) monitoring.
Interventions
DRUGDesflurane
After induction, anesthesia will be maintained with 0.7-1.0 MAC desflurane and remifentanil 0.05-0.2 μg/kg/min
DRUGDesflurane, Propofol
After induction, anesthesia will be maintained with 0.5 MAC desflurane, propofol 1.5-2.5 μg/ml and remifentanil 0.05-0.2 μg/kg/min
Sponsors
Beijing Tiantan Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Patients undergoing spinal cord surgery under elective general anesthesia; 2. At the same time, other electrophysiological monitoring is required; 3. 18-65 years old; 4. ASA I-III; 5. Sign the informed consent form.
Exclusion criteria
1. Patients with visual impairment; 2. Patients with severe liver and kidney function diseases; 3. History of asthma; Uncontrolled hypertension, diabetes, severe arrhythmia or unstable angina pectoris; 4. Have mental illness or unable to communicate; 5. BMI≥30kg/m2； 6. Abuse of analgesics and drug abuse history; 7. Silicone allergy; 8. Visual evoked potential monitoring was rejected.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| N75-p100 amplitude value | 60 minutes after anesthesia induction | Wave amplitude difference between N75-P100 peak and trough |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| P100-N145 amplitude decline rates | 30minutes and 60 minutes after anesthesia induction | The decrease rate of wave amplitude of P100-N145 under corresponding anesthesia maintenance methods compared to the baseline measurements under total intravenous anesthesia |
| P100 latency prolongation rate | 30minutes and 60 minutes after anesthesia induction | The rate of prolongation of P100 latency compared to the baseline measurements under total intravenous anesthesia |
| Success rate of FVEP monitoring | 30minutes and 60 minutes after anesthesia induction | The number of individuals obtaining satisfactory FVEP monitoring waveforms as a ratio to the total number of individuals monitored in each group |
| FVEPs stacking satisfaction | Intraoperative | Assessed by the electrophysiological monitoring physician, if good waveforms can be obtained with no more than three superimpositions, it is considered satisfactory |
| Respiratory recovery time | Within 60 minutes after surgery | The time from the cessation of anesthesia to the patient's spontaneous breathing recovery |
| N75-P100 amplitude decline rates | 30minutes and 60 minutes after anesthesia induction | The decrease rate of wave amplitude of P100-N145 under corresponding anesthesia maintenance methods compared to the baseline measurements under total intravenous anesthesia |
| Extubation time | Within 60 minutes after surgery | The time from the cessation of anesthesia to the removal of the patient's tracheal catheter |
| Postextubation agitation score | Immediately after extubation, 15 minutes after extubation, 30 minutes after extubation, 1 hour after extubation. | 1 point, calm sleep; 2 points, awake and calm; 3 points, irritable, easily agitated, crying; 4 points, difficult to console, uncontrollable crying; 5 points, unable to settle, confused, delirious. |
| Ramsay Sedation Score | Immediately after extubation, 15 minutes after extubation, 30 minutes after extubation, 1 hour after extubation. | 1 point - awake, anxious, and restless; 2 points - cooperative, oriented, and calm; 3 points - drowsy, responds to commands; 4 points - drowsy, responds promptly to light tapping on the forehead or loud auditory stimulation; 5 points - drowsy, responds sluggishly to light tapping on the forehead or loud auditory stimulation; 6 points - drowsy, unresponsive. Sedation is considered satisfactory with a score of 2-4, and excessive sedation with a score of 5-6. |
| Intraoperative anesthetic drugs dosage | The time period between the patient entering the operating room and leaving the operating room | Including the total amount of intraoperative application of sufentanil, remifentanil, propofol, and rocuronium |
| Intraoperative vasoactive drugs dosage | The time period between the patient entering the operating room and leaving the operating room | The total amount of norepinephrine, ephedrine, perdipine, and atropine used during surgery |
| Eye-opening time | Within 60 minutes after surgery | The time from anesthesia cessation to when the patient can be called to open their eyes |
Countries
China
Outcome results
None listed