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Article

Quantitative Analysis of the Effect of Neuromuscular Blockade on Motor-Evoked Potentials in Patients Undergoing Brain Tumor Removal Surgery: A Prospective, Single-Arm, Open-Label Observational Study

by
Dongwoo Chae
1,†,
Hyun-Chang Kim
2,†,
Hun Ho Park
3,
Jihwan Yoo
3,
Yoon Ghil Park
4,
Kyu Wan Kwak
4,
Dawoon Kim
4,
Jinyoung Park
4,‡ and
Dong Woo Han
2,*,‡
1
Department of Pharmacology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
2
Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
3
Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea
4
Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
These authors also contributed equally to this work.
J. Clin. Med. 2024, 13(15), 4281; https://doi.org/10.3390/jcm13154281
Submission received: 10 June 2024 / Revised: 17 July 2024 / Accepted: 20 July 2024 / Published: 23 July 2024
(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)
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Abstract

Background: We aimed to elucidate the quantitative relationship between the neuromuscular blockade depth and intraoperative motor-evoked potential amplitudes. Methods: This prospective, single-arm, open-label, observational study was conducted at a single university hospital in Seoul, Korea, and included 100 adult patients aged ≥19 years undergoing brain tumor removal surgery under general anesthesia. We measured the neuromuscular blockade degree and motor-evoked potential amplitude in the deltoid, abductor pollicis brevis, tibialis anterior, and abductor hallucis muscles until dural opening. Results: The pharmacokinetic-pharmacodynamic model revealed the exposure-response relationship between the rocuronium effect-site concentration and motor-evoked potential amplitudes. The mean motor-evoked potential amplitudes decreased proportionally with increasing neuromuscular blockade depth. As the mean amplitude increased, the coefficient of variation decreased bi-exponentially. The critical ratio of the first evoked response to the train-of-four stimulation (T1)/control response (Tc) thresholds beyond which the coefficient of variation exhibited minimal change were found to be 0.63, 0.65, 0.68, and 0.63 for the deltoid, abductor pollicis brevis, tibialis anterior, and abductor hallucis muscles, respectively. Conclusions: Our results reveal that the motor-evoked potential amplitude exhibits deterioration proportional to the degree of neuromuscular blockade. In light of the observed bi-exponential decline of the coefficient of variation with the motor-evoked potential amplitude, we recommend maintaining a T1/Tc ratio higher than 0.6 for partial neuromuscular blockade.
Keywords: brain neoplasm; electric impedance; motor-evoked potential; neuromuscular blockers; transcranial magnetic stimulation brain neoplasm; electric impedance; motor-evoked potential; neuromuscular blockers; transcranial magnetic stimulation

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MDPI and ACS Style

Chae, D.; Kim, H.-C.; Park, H.H.; Yoo, J.; Park, Y.G.; Kwak, K.W.; Kim, D.; Park, J.; Han, D.W. Quantitative Analysis of the Effect of Neuromuscular Blockade on Motor-Evoked Potentials in Patients Undergoing Brain Tumor Removal Surgery: A Prospective, Single-Arm, Open-Label Observational Study. J. Clin. Med. 2024, 13, 4281. https://doi.org/10.3390/jcm13154281

AMA Style

Chae D, Kim H-C, Park HH, Yoo J, Park YG, Kwak KW, Kim D, Park J, Han DW. Quantitative Analysis of the Effect of Neuromuscular Blockade on Motor-Evoked Potentials in Patients Undergoing Brain Tumor Removal Surgery: A Prospective, Single-Arm, Open-Label Observational Study. Journal of Clinical Medicine. 2024; 13(15):4281. https://doi.org/10.3390/jcm13154281

Chicago/Turabian Style

Chae, Dongwoo, Hyun-Chang Kim, Hun Ho Park, Jihwan Yoo, Yoon Ghil Park, Kyu Wan Kwak, Dawoon Kim, Jinyoung Park, and Dong Woo Han. 2024. "Quantitative Analysis of the Effect of Neuromuscular Blockade on Motor-Evoked Potentials in Patients Undergoing Brain Tumor Removal Surgery: A Prospective, Single-Arm, Open-Label Observational Study" Journal of Clinical Medicine 13, no. 15: 4281. https://doi.org/10.3390/jcm13154281

APA Style

Chae, D., Kim, H.-C., Park, H. H., Yoo, J., Park, Y. G., Kwak, K. W., Kim, D., Park, J., & Han, D. W. (2024). Quantitative Analysis of the Effect of Neuromuscular Blockade on Motor-Evoked Potentials in Patients Undergoing Brain Tumor Removal Surgery: A Prospective, Single-Arm, Open-Label Observational Study. Journal of Clinical Medicine, 13(15), 4281. https://doi.org/10.3390/jcm13154281

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