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Impact of inhalation vs. intravenous anaesthesia on autonomic nerves and internal anal sphincter tone
Author(s) -
Heid F.,
Kauff D. W.,
Lang H.,
Kneist W.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12535
Subject(s) - medicine , anesthesia , interquartile range , sevoflurane , propofol , internal anal sphincter , electromyography , autonomic nervous system , surgery , anal canal , heart rate , rectum , blood pressure , psychiatry
Background Pelvic intraoperative neuromonitoring ( pIONM ) aims to identify and spare the autonomic nerves and maintain patients’ quality of life. The effect of anaesthetic agents on the pIONM signal is unknown; therefore, the aim of the present study was to compare the influences of inhalation anaesthesia ( IA ) and total intravenous anaesthesia ( TIVA ). Methods Twenty rectal cancer patients undergoing open nerve‐sparing total mesorectal excision ( TME ) were assigned to pIONM under either IA or TIVA ( n = 10 per group). IA was maintained with sevoflurane and TIVA with propofol. During surgery, pelvic autonomic nerves were electrically stimulated under electromyography ( EMG ) of the internal anal sphincter ( IAS ). These triggered EMG signals were analysed. Results The absolute EMG amplitude during pIONM increased to 1.20 μV (interquartile range ( IQR ): 0.94–1.6) for IA and 1.49 μV ( IQR : 0.84–2.75) for TIVA ( P = 0.002). The relative EMG amplitude increase also was significantly lower for IA (0.59; IQR : 0.30–0.81; TIVA : 0.99; IQR : 0.62–2.5), ( P = 0.001). Conclusions This is the first study to compare the influences of IA and TIVA on the autonomic nervous system. While both anaesthetic regimens proved useful for pIONM , TIVA with propofol may provide better signal quality than IA with sevoflurane.