Neuroanesthesia & neurocritical care
The Influence of Anesthetic and Surgical Factors on Spinal Late Motor Responses: A Systematic Review
Authors' conclusion
This systematic review demonstrates that H-reflexes and F-waves are significantly influenced by anesthetic factors. The reviewed studies indicate that intravenous and volatile anesthetics significantly affect late responses, by reducing H-reflex and F-wave amplitudes, whereas latencies appear unaffected. The methodological quality varied significantly across the included studies and affects the interpretation of their conclusions. These findings support the potential integration of late response monitoring into intraoperative neurophysiological monitoring (IONM) protocols, provided that anesthetic management and surgical context are carefully considered.
Study context
- Population
- Studies of late response (F-wave and H-reflex) recording assessing the influence of anesthetic and surgical factorsstudies included
- Participants
- 62 studies
- Outcome
- Respiratory conditions
Pooled result
As reported in the abstract
- Hypercapnia reduced H-reflex amplitude; hyperoxia and intermittent hypoxia had limited impact
Further pooled results
Volatile agents (isoflurane, sevoflurane, nitrous oxide)
- Decreased late response amplitudes, with dose-dependent effects
Intravenous anesthetics
- Most, particularly propofol, reduced H-reflex amplitude and F-wave persistence in a dose-dependent manner
- Ketamine increased H-reflex amplitude
H-reflex monitoring during spinal and vascular surgeries
- Feasible and provided valuable supplementary data to motor evoked potential (MEP) and SSEP modalities
Methodological quality (QUADAS-2)
- Methodological quality varied significantly across the included studies
Original publication
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