Effect of TIVA With Magnesium Sulfate on IONM in Patients Undergoing Spine Surgery

Study Overview
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Brief Summary
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Anesthesia for neurosurgery requires balancing deep and effective anesthesia as well as postoperative analgesia versus the risks of delayed recovery and postoperative respiratory depression. This randomized placebo-controlled, double-blind study was designed to evaluate the effect of magnesium sulfate on the total anesthetic and analgesic consumption using the clinical parameters in addition to the effect on IONM reading.

Detailed Description
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Objectives: Decrease anesthetic consumption Decrease use of muscle relaxants Decrease analgesic consumption Excellent recovery Patients & Methods: 2 groups (total 50) Randomized Controlled Double Blind (RCDB) Study Propofol + remifentanil + saline (Control = C group) Propofol + remifentanil + Mgso4 (Magnesium = M group) Adult Spine decompression and fixation After getting the Institutional Review Board (IRB) approval, This randomized controlled double blind study includes 2 groups of patients (each group 25) will be enrolled in the study. All patients undergo spine decompression and fixation surgery Induction: All patients in the study will receive iv fentanyl 2 mic/kg + propofol 2mg/kg and endotracheal intubation will be facilitated with rocuronium 0.60 mg/ kg. Then anesthesia will be maintained using total intravenous anesthesia with propofol (6-9 mg/kg/hr) + remifentanil (0.03-0.05 mic / kg/ min) Group 1 (C group) : Receive 10 mg/kg /hr 0.9% Normal Saline Group 2 (M group) : Receive 10 mg/kg/hr Magnesium Sulfate Monitoring: IONM train-of-four (TOF) bispectral index (BIS) Measurements: IO Anesthetic Consumption IO Hemodynamics somatosensory evoked potential (SSEP), motor evoked potential (MEP), TOF, BIS Readings PO visual analogue scale (VAS) (24hours) PO Morphine Consumption (24hours)

Official Title
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Effect of Total Intravenous Anesthesia (TIVA) With Magnesium Sulfate on Intra-Operative Neuromonitoring (IONM) in Patients Undergoing Spine Surgery

Conditions
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Spine Surgery

Intervention / Treatment
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* Procedure: Spine Surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult Patients Undergoing Spine Surgery Exclusion Criteria: Renal Impairment Liver Cell failure Heart Block

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| magnesium sulfate effect on IONM reading in spine surgery<br>one group receives magnesium other do not | Procedure: Spine Surgery<br>* spine decompression and fixation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| IONM Reading | Reading the effect on the intraoperative neuromonitoring either motor or sensory evoked potential | 1- baseline 2-during surgery 3-immediately after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood Pressure | Systolic, Diastolic and Mean (mmHg) | 1- baseline 2-during surgery 3-immediately after surgery 4- every one hour postoperative till 24 hours | 
| Heart Rate | beats/min | 1- baseline 2-during surgery 3-immediately after surgery 4- every one hour postoperative till 24 hours | 
| Morphine Consumption | Total morphine consumed over 24 hours in mg | Over 24 hours postoperative | 
| Pain Score | 11 Visual Analogue Scale (VAS) with 10 is the worst and 0 is the least | Over 24 hours postoperative |