Non-linear regression analysis for estimating the intraoperative motor evoked potential recovery time after bolus neurom
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ORIGINAL RESEARCH
Non‑linear regression analysis for estimating the intraoperative motor evoked potential recovery time after bolus neuromuscular blockade Tetsuro Tatsuoka1 · Tasuku Fujii2 · Takeshi Furuhashi1 · Kimitoshi Nishiwaki2 Received: 8 December 2019 / Accepted: 28 September 2020 © Springer Nature B.V. 2020
Abstract The recovery time of the motor evoked potential (MEP) amplitude following a neuromuscular blockade (NMB) during surgery is useful for interpreting low-amplitude waveforms or selecting the baseline waveform. In this study, the MEP data of 195 orthopedic cases who received a bolus dose of rocuronium at the beginning of surgery, between June 2009 and January 2016 were used. A non-linear regression analysis was applied to MEP amplitude data of multiple patients. The time taken for 90% of the maximum-amplitude recovery was estimated from the identified time series model. The 90% amplitude recovery time was 88.6 min in the pharmacological model and 89.4 min in the logistic model. These results were included in the 95% confidence interval of the previous studies. Although MEP amplitude is relatively unstable because of anesthesia, the averaged time series model of MEP amplitude can be estimated by using a large number of data. Keywords Motor evoked potential · MEP · Non-depolarizing muscle relaxant · Neuromuscular blockade · Non-linear regression analysis · Pharmacokinetics model · Pharmacodynamics model
1 Introduction The motor evoked potential (MEP) is used for monitoring motor function during spinal surgery to prevent postoperative paralysis. The amplitude ratio based on the baseline waveform is used as the monitoring index [1]. Neuromuscular blockade (NMB) during general anesthesia induction affects the MEP waveforms, and makes it ‘no-response’ or ‘low amplitude’ at the beginning of surgery [2, 3]. The MEP amplitude recovery time following NMB is useful for interpreting low-amplitude waveforms or selecting the baseline waveform during surgery [4]. Furthermore, estimating MEP amplitude recovery before the surgical procedure could reduce or exclude the administration of NMB reversal Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-020-00600-0) contains supplementary material, which is available to authorized users. * Tetsuro Tatsuoka [email protected]‑u.ac.jp 1
Department of Information and Communication Engineering, Graduate School of Engineering, Nagoya University, Furo‑cho, Chikusa‑ku, Nagoya 464‑8603, Japan
Department of Anesthesiology, Nagoya University Hospital, 65 Tsurumai‑cho, Showa‑ku, Nagoya 466‑8550, Japan
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agents [5] for early derivation of the baseline waveform. It has been reported that the incidence of anaphylaxis potentially caused by sugammadex, a widely used NMB reversal agent, was 0.04% [6]; therefore, reducing usage of sugammadex will reduce the risk of anaphylaxis. In addition, although sugammadex is cost-effective, it is an expensive drug [7], and it is desirable to reduce unnecessary medical e
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