Influence of hemorrhage and subsequent fluid resuscitation on transcranial motor-evoked potentials under desflurane anesthesia in a swine model

Abstract

Purpose

Hemorrhage increases the effect of propofol and could contribute to false-positive transcranial motor-evoked potential (TcMEP) responses under total intravenous anesthesia (TIVA). We investigated the influence of hemorrhage and subsequent fluid resuscitation on TcMEPs under desflurane anesthesia.

Methods

Sixteen swine (25.4 ± 0.4 kg) were anesthetized with a 4% end-tidal desflurane concentration (EtDes), which was incrementally increased to 6%, 8%, and 10% and then returned to 4% every 15 min. This procedure was repeated twice (baseline). After baseline measurements, animals were allocated to either the hemorrhage (n = 12) or control (n = 4) group. In the hemorrhage group, 600 ml of blood was removed and the EtDes protocol described above was applied. Hypovolemia was resuscitated using 600 ml of hydroxyethyl starch and the EtDes protocol was applied again. TcMEPs were measured at each EtDes. In the control group, measurements were performed without hemorrhage or fluid infusion.

Results

TcMEP responses were observed in all conditions in all limbs with 4% EtDes (0.4 MAC). TcMEP amplitudes decreased according to the EtDes to a greater degree in the lower limbs compared with the upper limbs. Hemorrhage enhanced the effect of desflurane on TcMEP amplitudes, and decreased TcMEP by 41 ± 12% in upper limbs and 63 ± 17% in lower limbs compared with baseline. Subsequent fluid resuscitation did not reverse TcMEP amplitudes.

Conclusions

TcMEP amplitudes decrease during hemorrhage under desflurane anesthesia. This phenomenon might result from an enhanced effect of desflurane on the spinal motor pathway without increasing the desflurane concentration.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Emily Woodhouse, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

Funding

Support was received solely from institutional and/or departmental sources.

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Authors

Contributions

TK contributed to the study design, data collection, analysis of data, and manuscript preparation. SK contributed to the study design and data collection. MMSIK contributed to the data collection and analysis of data. YN contributed to the study design. The first and revised drafts of the manuscript were written by TK, and all authors read and approved the final manuscript.

Corresponding author

Correspondence to Tadayoshi Kurita.

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Conflict of interest

The authors have no conflicts of interest to declare.

Human and Animal rights

This study was approved by the Committee of the Animal Research Division at Hamamatsu University School of Medicine (approval number 2019052).

Ethical approval

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution at which the studies were conducted (The Committee of the Animal Research Division at Hamamatsu University School of Medicine, approval number 2019052). This article does not contain any studies with human participants performed by any of the authors.

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Kurita, T., Kawashima, S., Ibrahim Khaleelullah, M.M.S. et al. Influence of hemorrhage and subsequent fluid resuscitation on transcranial motor-evoked potentials under desflurane anesthesia in a swine model. J Clin Monit Comput (2021). https://doi.org/10.1007/s10877-020-00644-2

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Keywords

  • Desflurane
  • Motor evoked potentials
  • Hemorrhage
  • Hypovolemia
  • Spinal cord