Intraoperative flash visual evoked potentials (FVEPs) can be used to monitor the integrity of the visual pathway in real-time during surgeries, and is to prevent the damage and deterioration of visual function caused by visual pathway damage, which is the key method of intraoperative monitoring of visual function. Spinal surgery in the prone position may compress the eyeball and reduce the blood supply of the ophthalmic artery, which is still one of the main causes of postoperative visual impairment. Intraoperative FVEPs monitoring is easily affected by inhale anesthetics, and there is little studies on the effect of intravenous-inhalation balanced anesthesia on FVEPs monitoring. Desflurane wakes up quickly, which is conducive to the recovery of early respiratory function and orientation, and early neurological evaluation. This study aims to compare the effects of desflurane-propofol balanced anesthesia and desflurane pure inhalation anesthesia on the amplitude and latency of FVEPs during spinal surgery under the same sedation depth monitored by bispectral index (BIS) monitoring.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
70
After induction, anesthesia will be maintained with 0.7-1.0 MAC desflurane and remifentanil 0.05-0.2 μg/kg/min
After induction, anesthesia will be maintained with 0.5 MAC desflurane, propofol 1.5-2.5 μg/ml and remifentanil 0.05-0.2 μg/kg/min
Beijing Tiantan Hospital
Beijing, China
N75-p100 amplitude value
Wave amplitude difference between N75-P100 peak and trough
Time frame: 60 minutes after anesthesia induction
N75-P100 amplitude decline rates
The decrease rate of wave amplitude of P100-N145 under corresponding anesthesia maintenance methods compared to the baseline measurements under total intravenous anesthesia
Time frame: 30minutes and 60 minutes after anesthesia induction
P100-N145 amplitude decline rates
The decrease rate of wave amplitude of P100-N145 under corresponding anesthesia maintenance methods compared to the baseline measurements under total intravenous anesthesia
Time frame: 30minutes and 60 minutes after anesthesia induction
P100 latency prolongation rate
The rate of prolongation of P100 latency compared to the baseline measurements under total intravenous anesthesia
Time frame: 30minutes and 60 minutes after anesthesia induction
Success rate of FVEP monitoring
The number of individuals obtaining satisfactory FVEP monitoring waveforms as a ratio to the total number of individuals monitored in each group
Time frame: 30minutes and 60 minutes after anesthesia induction
FVEPs stacking satisfaction
Assessed by the electrophysiological monitoring physician, if good waveforms can be obtained with no more than three superimpositions, it is considered satisfactory
Time frame: Intraoperative
Respiratory recovery time
The time from the cessation of anesthesia to the patient's spontaneous breathing recovery
Time frame: Within 60 minutes after surgery
Eye-opening time
The time from anesthesia cessation to when the patient can be called to open their eyes
Time frame: Within 60 minutes after surgery
Extubation time
The time from the cessation of anesthesia to the removal of the patient's tracheal catheter
Time frame: Within 60 minutes after surgery
Postextubation agitation score
1 point, calm sleep; 2 points, awake and calm; 3 points, irritable, easily agitated, crying; 4 points, difficult to console, uncontrollable crying; 5 points, unable to settle, confused, delirious.
Time frame: Immediately after extubation, 15 minutes after extubation, 30 minutes after extubation, 1 hour after extubation.
Ramsay Sedation Score
1 point - awake, anxious, and restless; 2 points - cooperative, oriented, and calm; 3 points - drowsy, responds to commands; 4 points - drowsy, responds promptly to light tapping on the forehead or loud auditory stimulation; 5 points - drowsy, responds sluggishly to light tapping on the forehead or loud auditory stimulation; 6 points - drowsy, unresponsive. Sedation is considered satisfactory with a score of 2-4, and excessive sedation with a score of 5-6.
Time frame: Immediately after extubation, 15 minutes after extubation, 30 minutes after extubation, 1 hour after extubation.
Intraoperative anesthetic drugs dosage
Including the total amount of intraoperative application of sufentanil, remifentanil, propofol, and rocuronium
Time frame: The time period between the patient entering the operating room and leaving the operating room
Intraoperative vasoactive drugs dosage
The total amount of norepinephrine, ephedrine, perdipine, and atropine used during surgery
Time frame: The time period between the patient entering the operating room and leaving the operating room
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