Effect of Magnesium on Neuromonitoring

Summary

Intraoperative neurophysiologic monitoring (IONM) is commonly used during complex spinal surgery to monitor the integrity of neural structures and improve the perioperative safety profile. Transcranial Motor Evoked Potentials (TcMEPs) monitor the integrity of the motor pathways and are one of the most commonly used monitoring modalities in spinal surgery. Because inhaled anesthetics can negatively affect the ability to monitor TcMEPs, anesthesiologists commonly use a combination of propofol and opioids to maintain the anesthetic state. Additionally, anesthesiologists will frequently administer intravenous infusions of medications that can decrease postoperative pain and opioid use (called opioid-sparing adjuncts) because spinal surgeries result in significant postoperative pain. Despite the increasing use of these agents, there is scant clinical data about how they may affect the integrity of TcMEP monitoring. Magnesium (Mg), a N-methyl-d-aspartate receptors (NMDA) receptor antagonist, is one of the adjuncts with robust data supporting clinical efficacy to decrease pain and opioid use on TcMEPs. Mg has been used clinically for decades. The investigators commonly utilize intravenous magnesium as a component of our spinal anesthesia protocol. However, there is only a single case report that discusses the effects of Mg on TcMEPs. Here the investigators propose a prospective clinical trial to quantitatively assess the effects of various Mg plasma levels on TcMEPs. There is a lack of literature on the pharmacokinetics of magnesium in non-pregnant patients.

Timeline

Start

2025-07-01

Primary completion

2026-04-30

Completion

2026-04-30

Publications

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• Background Johnson T, Kale EB, Husain AM. Magnesium Sulfate-Induced Motor Evoked Potential Changes. Neurodiagn J. 2018;58(2):83-90. doi: 10.1080/21646821.2018.1469336.
• Background Wang H, Liang QS, Cheng LR, Li XH, Fu W, Dai WT, Li ST. Magnesium sulfate enhances non-depolarizing muscle relaxant vecuronium action at adult muscle-type nicotinic acetylcholine receptor in vitro. Acta Pharmacol Sin. 2011 Dec;32(12):1454-9. doi: 10.1038/aps.2011.117. Epub 2011 Oct 10.
• Background Yue L, Lin ZM, Mu GZ, Sun HL. Impact of intraoperative intravenous magnesium on spine surgery: A systematic review and meta-analysis of randomized controlled trials. EClinicalMedicine. 2022 Jan 5;43:101246. doi: 10.1016/j.eclinm.2021.101246. eCollection 2022 Jan.
• Background Martell BA, Arnsten JH, Krantz MJ, Gourevitch MN. Impact of methadone treatment on cardiac repolarization and conduction in opioid users. Am J Cardiol. 2005 Apr 1;95(7):915-8. doi: 10.1016/j.amjcard.2004.11.055.
• Background Furutani K, Deguchi H, Matsuhashi M, Mitsuma Y, Kamiya Y, Baba H. A Bolus Dose of Ketamine Reduces the Amplitude of the Transcranial Electrical Motor-evoked Potential: A Randomized, Double-blinded, Placebo-controlled Study. J Neurosurg Anesthesiol. 2021 Jul 1;33(3):230-238. doi: 10.1097/ANA.0000000000000653.
• Background Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996 Feb;84(2):340-7. doi: 10.1097/00000542-199602000-00011.
• Background Herdmann J, Deletis V, Edmonds HL Jr, Morota N. Spinal cord and nerve root monitoring in spine surgery and related procedures. Spine (Phila Pa 1976). 1996 Apr 1;21(7):879-85. doi: 10.1097/00007632-199604010-00023.
• Background Sloan TB, Heyer EJ. Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol. 2002 Oct;19(5):430-43. doi: 10.1097/00004691-200210000-00006.
• Background Macdonald DB, Skinner S, Shils J, Yingling C; American Society of Neurophysiological Monitoring. Intraoperative motor evoked potential monitoring - a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol. 2013 Dec;124(12):2291-316. doi: 10.1016/j.clinph.2013.07.025. Epub 2013 Sep 18.

Drugs

Indications

No indication recorded.