Evaluation of the Effect of Continuous Infusion of Dexmedetomidine or a Subanesthetic Dose Ketamine on Transcranial Electrical Motor Evoked Potentials in Adult Patients Undergoing Elective Spine Surgery under Total Intravenous Anesthesia: A Randomized Controlled Exploratory Study

STUDY DESIGN: Prospective, randomized, placebo-controlled, double-blind exploratory study. PURPOSE: To compare effects of dexmedetomidine or a subanesthetic dose of ketamine on the amplitude and latency of transcranial electrically generated motor evoked potentials. OVERVIEW OF LITERATURE: Total intravenous anesthesia (TIVA) is a standard anesthesia technique for transcranial electrical motor evoked potential monitoring in spine surgery. We aimed to determine whether the use of dexmedetomidine and ketamine as a component of TIVA exerted any beneficial effect on the quality of monitoring. METHODS: A total of 90 American Society of Anesthesiologist grade I–III patients, aged 18–65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol–fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation). RESULTS: Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%–100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p<0.05). CONCLUSIONS: The present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.