Transcranial Motor Evoked Potential Monitoring Using Propofol-Fentanyl Versus Desflurane-Dexmedetomidine Anesthesia During Spinal Cord Tumor Resection: A Randomized Controlled Trial.
Jennifer Shalini Ravikumar, Srinivas Babu, Bijesh R Nair et al.
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In 30 seconds
This prospective, double-blinded, single-centre randomised controlled trial compared propofol-fentanyl with desflurane-dexmedetomidine in 50 adults undergoing spinal cord tumour resection with transcranial motor evoked potential monitoring. MEPs of at least 50 µV were recorded in 80% of the propofol-fentanyl group and 76% of the desflurane-dexmedetomidine group (95% CI: -23% to 31%, P =1.00), indicating similar monitoring success. The desflurane-dexmedetomidine group had shorter recovery milestones and lower postoperative pain scores at 12 and 24 hours.
Key findings
- MEPs were recorded in 80% with propofol-fentanyl and 76% with desflurane-dexmedetomidine (95% CI: -23% to 31%, P =1.00).
- Mean emergence time was 33.68±18.11 minutes with propofol-fentanyl versus 10.92±4.01 minutes with desflurane-dexmedetomidine (P =0.001).
- Discharge readiness took 45.00±25.24 minutes versus 15.56±6.08 minutes, respectively (P =0.001).
- Postoperative pain scores were lower with desflurane-dexmedetomidine at 12 and 24 hours (P =0.001 at both time points).
Why it matters
Reliable MEP monitoring is important during spinal cord tumour resection, and anaesthetic choice may also affect recovery and postoperative pain. In this trial, the two regimens had similar observed monitoring success, while desflurane-dexmedetomidine was associated with faster recovery milestones and lower pain scores. These findings help frame the trade-offs clinicians may consider when selecting an anaesthetic regimen for this setting.
What to keep in mind
The trial was single-centre and included 50 patients; the confidence interval around the difference in MEP recording rates was wide.