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NEUROSURGICAL ANESTHESIA

S(+)-Ketamine Attenuates Myogenic Motor-Evoked Potentials at or Distal to the Spinal -Motoneuron

Kai-Michael Scheufler, MD^*, Christof Thees, MD, Joachim Nadstawek, MD, PhD, and Josef Zentner, MD, PhD^*

*Department of NeurosurgeryUniversity of Freiburg, Freiburg, Germany; and Department of Anesthesiology and Intensive Care MedicineUniversity of Bonn, Bonn, Germany

Address correspondence and reprint requests to Kai-Michael Scheufler, MD, Abt. Allgemeine Neurochirurgie, Universitätsklinikum Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany. Address e-mail to scheufle{at}nz11.ukl.uni-freiburg.de

We investigated the effect of S(+)-ketamine on spinal cord evoked potentials (ESCPs) and myogenic motor-evoked potentials after electrical stimulation of the motor cortex in a rabbit model. This study was designed to characterize the relationship between ESCP characteristics and corresponding changes in compound muscle action potentials (CMAPs) derived from fore and hind limbs. Direct (D) and indirect (I) corticospinal volleys (ESCP) from the upper and lower thoracic spinal cord, recorded by two bipolar epidural electrodes, were assessed during IV administration of 0.02, 0.05, 0.1, and 0.2 mg · kg^-1 · min^-1 of S(+)-ketamine, each before and after neuromuscular blockade (0.4 mg/kg of cisatracurium), in 16 New Zealand White rabbits after single-pulse bipolar electrical stimulation of the motor cortex at 50 (threshold), 60, and 70 V. CMAP amplitudes at fore and hind limbs were significantly suppressed (P < 0.01) during infusion at 0.1 and 0.2 mL · kg^-1 · min^-1, whereas neither corresponding D- nor I-waves were altered. Similar findings were obtained during variation of stimulus amplitude (50–70 V). Multivariate regression analysis of CMAP amplitudes and various ESCP characteristics demonstrated no apparent interparametric association. These findings indicate that S(+)-ketamine modulates CMAP independent from corticospinal D- and I-wave-mediated facilitation at or distal to the spinal -motoneuron.

IMPLICATIONS: S(+)-Ketamine combines several anesthetic properties suitable for total IV neuroanesthesia, including minimal effects on neurophysiological monitoring. Recording of neural and myogenic responses after electrical stimulation of the motor cortex indicates that S(+)-ketamine modulates myogenic motor-evoked potentials by a peripheral mechanism at or distal to the spinal -motoneuron.