Stimulation parameters for motor evoked potentials during intraoperative spinal cord monitoring. A systematic review. 2023

S E Dulfer, and M C Gadella, and M M Sahinovic, and F Lange, and A R Absalom, and R J M Groen, and A Szelényi, and G Drost
Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: s.e.dulfer@umcg.nl.

The aim of this systematic review was to find the optimal stimulation parameters for muscle recorded transcranial electrical stimulation motor evoked potential (mTc-MEP) and D-wave monitoring during spinal cord monitoring. A PRISMA systematic search in Medline and EMBASE and a QUADAS-2 quality evaluation was performed to identify studies that compared stimulation parameters consisting of stimulation location, number of pulses, pulse duration, interstimulus interval, double train (DTS) or recurrent train stimulation (RTS) and intertrain interval (ITI) for performing mTc-MEP and D-wave monitoring. Only studies that used total intravenous anaesthesia (TIVA) were included. Ten studies that compared stimulation parameters for performing mTc-MEP monitoring (stimulation location n = 4, number of pulses n = 2, pulse duration n = 1, interstimulus interval n = 4, DTS n = 1, RTS n = 2, ITI n = 2) were included. No studies compared stimulation parameters (stimulation location and pulse duration) for performing D-wave monitoring. Few studies examined the optimal stimulation parameters for monitoring mTc-MEPs and no studies were included for D-wave monitoring. There is a need for prospective research to investigate the optimal stimulation parameters for mTc-MEP with the use of TIVA and D-wave monitoring. For mTc-MEP monitoring, a table is provided in which the recommended stimulation parameters are stated.

UI MeSH Term Description Entries
D004558 Electric Stimulation Use of electric potential or currents to elicit biological responses. Stimulation, Electric,Electrical Stimulation,Electric Stimulations,Electrical Stimulations,Stimulation, Electrical,Stimulations, Electric,Stimulations, Electrical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000768 Anesthesia, General Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery. Anesthesias, General,General Anesthesia,General Anesthesias
D013116 Spinal Cord A cylindrical column of tissue that lies within the vertebral canal. It is composed of WHITE MATTER and GRAY MATTER. Coccygeal Cord,Conus Medullaris,Conus Terminalis,Lumbar Cord,Medulla Spinalis,Myelon,Sacral Cord,Thoracic Cord,Coccygeal Cords,Conus Medullari,Conus Terminali,Cord, Coccygeal,Cord, Lumbar,Cord, Sacral,Cord, Spinal,Cord, Thoracic,Cords, Coccygeal,Cords, Lumbar,Cords, Sacral,Cords, Spinal,Cords, Thoracic,Lumbar Cords,Medulla Spinali,Medullari, Conus,Medullaris, Conus,Myelons,Sacral Cords,Spinal Cords,Spinali, Medulla,Spinalis, Medulla,Terminali, Conus,Terminalis, Conus,Thoracic Cords
D016343 Monitoring, Intraoperative The constant checking on the state or condition of a patient during the course of a surgical operation (e.g., checking of vital signs). Intraoperative Monitoring
D019054 Evoked Potentials, Motor The electrical response evoked in a muscle or motor nerve by electrical or magnetic stimulation. Common methods of stimulation are by transcranial electrical and TRANSCRANIAL MAGNETIC STIMULATION. It is often used for monitoring during neurosurgery. Motor Evoked Potentials,Evoked Potential, Motor,Motor Evoked Potential,Potential, Motor Evoked,Potentials, Motor Evoked

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