Discussion
neurological injuries, motor dysfunction
NEUROMUSCULAR BLOCKADE
TceMEP monitoring during spinal surgery can assess the functional integrity of motor pathways to early detect motor dysfunction and allow intervention before damage becomes irreversible [MEPs directly monitor the anterolateral columns and are helpful in detecting and preventing neurological injuries caused by anterior compression or by impaired blood flow to the anterior spinal cord. Changes in anesthetic management lead to changes in MEPs. Comparing with inhalational anesthetics, the benefits of intravenous agents for MEP monitoring are less interference with alpha motor neuron excitability [pNMB induced by continuously infusing a low-dose muscle relaxant can be used in spinal surgery requiring TceMEPs, and those who advocate for pNMB may be concerned about the complete omission of muscle relaxant resulting in difficulty in exposing the surgical field, and the risk of unexpected patient movement [Sugammadex can quickly and safely reverse neuromuscular blockade by encapsulating rocuronium and vecuronium, enabling complete recovery of neuromuscular function. Previous studies have explored the effect of sugammadex on the amplitudes of TceMEP monitoring. Venkatraghavan et al. [Previous study has revealed sugammadex can cause cortical arousal and increased the BIS values [There are some limitations to our study. We chose TceMEPs signals from upper extremities during surgical procedures on the thoracic or lumbar spine in our study, allowing the neurophysiological team to isolate changes that occur only in the lower extremities (which are a result of surgical technique) from changes in the upper extremity signals (which may be caused by anesthetic managements) to avoid the interference of surgery manipulation. This may limit the generalization of our data to other muscle groups, especially from the lower extremities, due to the difference in the recovery rate of each muscle. Second, some concerns may be raised about unexpected patient movement that develops after the administration of sugammadex [