Clinical Application Of Intravenous Lidocaine In Neurophysiological Monitoring During Neurosurgery

Objective:To investigate the effect of intraoperative intraoperative neurophysiological monitoring（IONM）and anesthesia in neurosurgery patients under intravenous compound anesthesia.Methods:A total of 60 patients undergoing IONM under elective general anesthesia for neuro-oncological surgery at the First Hospital of Jilin University from April2021 to December 2021 were included.The random number table method was adopted and 60 patients were randomized into two groups: Lidocaine（L）group（n = 30）and control（C）group（n = 30）.Two groups of patients were routinely fasted and prohibited from drinking before surgery,routine monitoring of ECG and vital signs after entering the operation room,and lidocaine group and control group were given etomidate 0.2-0.6 mg/kg,sufentanil 0.3 μg/kg and cisatracurium 0.15 mg/kg during anesthesia induction.Lidocaine group was given1.5 mg/kg loading dose during induction,while the control group was given an equal amount of 0.9 sodium chloride injection.During anesthesia maintenance,sevoflurane was maintained at 0.5 minimum alveolar concentration（MAC）,remifentanil pumping rate was 5-30 μg/（kg·h）,propofol pumping rate was 4-12mg/（kg·h）.Lidocaine group was pumped with 1.5 mg/（kg·h）lidocaine,and control group was pumped with the same amount of 0.9% sodium chloride solution intravenously.Mean arterial pressure（MAP）,heart rate,（HR）and bispectral index（BIS）scores were recorded before anesthesia induction（T0）,5min after intubation（T1）,skin incision（T2）,dural incision（T3）,and tumor separation（T4）.The N20 and P40 amplitude incubation periods of somatosensory evoked potentials（SSEP）and transcranial electric motor evoked potentials（Tce-MEP）were recorded 30 minutes after the completion of anesthesia induction,as the basic value of each wave amplitude and incubation period during neural monitoring.The wave amplitude and latency of each wave were recorded during the intraoperative separation and resection of the tumor and after the completion of tumor resection.The dosage,total amount,anesthesia time,and operation time used by the two groups of patients during intraoperative maintenance of anesthesia were recorded Results:1.There were no significant differences in age,sex,body mass index,duration of anesthesia,duration of surgery and BIS scores between the two groups（P>0.05）.2.In terms of hemodynamic indexes,the intraoperative MAP and HR were lower in group L compared with group C from T1 to T4,and the difference between the two groups was statistically significant（P<0.05）;the incidence of hypertension and tachycardia was lower in group L compared with group C,and the incidence of bradycardia was higher,and the difference between the two groups was statistically significant（P<0.05）.3.In terms of evoked potentials,both group L and group C were able to successfully evoke SSEP and Tce-MEP,and the differences in Tce-MEP wave amplitude and latency between the two groups of patients at each time point were not statistically significant（P>0.05）;the differences in SSEP wave amplitude and latency between the two groups of patients at 30 min after induction and after tumor resection were not statistically significant（P>0.05）,patients in group C showed a statistically significant decrease and prolongation of SSEP wave amplitude and latency intraoperatively compared with the basal values and intraoperative in group L,and the differences were statistically significant（P<0.05）.4.In terms of intravenous anesthetic drug dosage,the intravenous anesthetic drugs propofol and opioids used in group L were significantly reduced compared with group C,and the differences between the two groups were statistically significant（P<0.05）.Conclusion:In neurosurgery,the intravenous application of lidocaine under silent compound anesthesia will not interfere with IONM,while meeting the anesthesia effect,it can reduce the application of propofol and opioids during surgery,reduce the adverse effects of anesthetic drugs on neurophysiological monitoring,improve the quality of neuroelectrophysiological monitoring,and also effectively reduce a series of adverse reactions caused by intravenous anesthetics to patients,which can ensure that the hemodynamics of patients are maintained in a relatively stable state.It effectively reduces the incidence of adverse events and stress reactions such as intraoperative hypertension and tachycardia,provides good conditions for neurophysiological monitoring,and is recommended for neurosurgical anesthesia requiring INOM.