Anaesthesia and Intraoperative Neurophysiological Monitoring in Surgical Correction of Idiopathic Scoliosis in Childhood

Abstract

The objective of this study is to compare the effectiveness of intraoperative neurophysiological monitoring (IONM) using two types of anaesthesia: combined anaesthesia and total intravenous anaesthesia (TIVA).

This retrospective study included 155 paediatric patients undergoing surgery for idiopathic scoliosis. The patients were divided into two groups based on the administered anaesthesia type: combined (inhalation and intravenous) anaesthesia group (n = 63) and TIVA group (n = 92). Multimodal neurophysiological monitoring techniques were applied, including somatosensory evoked potentials (SSEP), transcranial motor evoked potentials (TCMEP), spontaneous and triggered electromyography, and electroencephalography. Specificity and intraoperative neurophysiological monitoring sensitivity of IONM were calculated for individual modalities as well as in total (SSEP + TCMEP).

In the postoperative period 7 patients (4.5%) were diagnosed with neurological complications. Only one case, a patient from the TIVA group, exhibited irreversible neurological complications. No statistically significant difference was found between the types of anaesthesia in terms of difficulties in recording baseline SSEP and TCMEP responses. False-positive SSEP potentials recorded under sevoflurane anaesthesia were three times more frequent than false-positive responses under TIVA, and this difference was statistically significant.

There was no statistically significant difference in the number of registered TCMEP changes between the two anaesthesia types. The specificity and sensitivity for the inhalation anaesthesia group were 90.38% and 90.91%, respectively. For patients receiving TIVA, the specificity and sensitivity were 97.5% and 100%, respectively.

This study concludes that IONM is applicable to both types of anaesthesia – combined and TIVA – if the type and dosage of anaesthetics are chosen correctly. Conducting IONM by the anaesthesia team enhances the interpretation of monitoring data, thereby increasing the effectiveness and reliability of IONM.