Evaluation of posttetanic motor evoked potentials--the influences of repetitive use, the residual effects of tetanic stimulation to peripheral nerve, and the variability

Recently, we developed a new technique to augment myogenic motor evoked potentials (MEPs), called as posttetanic MEPs (p-MEPs), in which tetanic stimulation is applied to peripheral nerve before transcranial stimulation. However, the data on p-MEPs are limited. This study was conducted; (1) to evaluate the influences of repetitive use of p-MEPs on p-MEP amplitudes, (2) to evaluate the residual effects of use of p-MEPs on subsequent conventional MEPs (c-MEPs), and (3) to compare the variability of p-MEPs with that of c-MEPs. Sixty patients under propofol/fentanyl anesthesia with partial neuromuscular blockade were enrolled. For p-MEP measurements, tetanic stimulation was applied to posterior tibial nerve 1 second before transcranial stimulation. In study 1, p-MEPs were repetitively recorded with intervals of 10 or 60 seconds. In study 2, the amplitudes of c-MEPs recorded 15, 30, 60, and 120 seconds after p-MEP recordings were compared with those of control. In study 3, the coefficients of variation of c-MEP and p-MEP responses were compared. The repetitive use of p-MEP with an interval of 10 seconds, but not 60 seconds, induced a significant reduction of p-MEP amplitude. Amplitudes of c-MEP were significantly increased when applied within 60 seconds after p-MEP recordings. The coefficient of variations of p-MEPs was similar to those of c-MEPs. The results indicated that the amplitudes of p-MEP and c-MEP might be affected when applied with a short interval after p-MEP recording.