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PEDIATRIC ANESTHESIA

The Effects of Propofol, Small-Dose Isoflurane, and Nitrous Oxide on Cortical Somatosensory Evoked Potential and Bispectral Index Monitoring in Adolescents Undergoing Spinal Fusion

Anthony J. Clapcich, MD^*, Ronald G. Emerson, MD, David P. Roye, Jr., MD, Hui Xie, PhD, Edward J. Gallo, REEGT, Kathy C. Dowling, REEGT, Brian Ramnath, REEGT, and Eric J. Heyer, MD^*

Departments of *Anesthesiology, Neurology, Orthopaedics, and Biostatistics, Children’s Hospital of New York, New York-Presbyterian Hospital, New York, New York

Address correspondence and reprint requests to Anthony J. Clapcich, MD, Children’s Hospital of New York, Broadway and West 166th Street, 4–440 North, New York, NY 10032. Address email to ajc60{at}columbia.edu

In this study we compared the effects of propofol, small-dose isoflurane, and nitrous oxide (N₂O) on cortical somatosensory evoked potentials (SSEP) and bispectral index (BIS) monitoring in adolescents undergoing spinal fusion. Twelve patients received the following anesthetic maintenance combinations in a randomly determined order: treatment #1: isoflurane 0.4% + N₂O 70% + O₂ 30%; treatment #2: isoflurane 0.6% + N₂O 70% + O₂ 30%; treatment #3: isoflurane 0.6% + air + O₂ 30%; treatment #4: propofol 120 µg · kg^–1 · min^–1 + air + O₂ 30%. Cortical SSEP amplitudes measured during anesthesia maintenance with treatment #3 (isoflurane 0.6%/air) were more than those measured during maintenance with treatment #1 (isoflurane 0.4%/N₂O 70%) (P < 0.0001) and treatment #2 (isoflurane 0.6%/N₂O 70%) (P < 0.0052). Cortical SSEP amplitudes measured during treatment #4 (propofol 120 µg · kg^–1 · min^–1/air) were more than treatment #1 (isoflurane 0.4%/N₂O 70%) (P < 0.0001), treatment #2 (Iso 0.6%/N₂O 70%) (P < 0.0007), and treatment #3 (isoflurane 0.6%/air) (P < 0.0191). In addition, average BIS values measured during treatments 1, 2, 3 and 4 were 62, 62, 61, and 44 respectively. Only treatment #4 (propofol 120 µg · kg^–1 · min^–1/air) uniformly maintained BIS values less than 60. Our study demonstrates that propofol better preserves cortical SSEP amplitude measurement and provides a deeper level of hypnosis as measured by BIS values than combinations of small-dose isoflurane/N₂O or small-dose isoflurane alone.

IMPLICATIONS: In adolescent patients undergoing spinal fusion, propofol better preserves cortical somatosensory evoked potential amplitude measurement and provides a deeper level of hypnosis as measured by bispectral index values than combinations of small-dose isoflurane-N₂O or small-dose isoflurane alone.

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