Median effective infusion rate (ED50) of continuous cisatracurium for preserving interpretable TceMEP signals during intraspinal tumor resection: a prospective up-and-down sequential allocation study.

@article{yan2026median,
  title = {{Median effective infusion rate (ED50) of continuous cisatracurium for preserving interpretable TceMEP signals during intraspinal tumor resection: a prospective up-and-down sequential allocation study.}},
  author = {Siyi Yan and Mengzhuo Guo and Xin Wen and Zhibin He},
  journal = {BMC anesthesiology},
  year = {2026},
  month = aug,
  doi = {10.1186/s12871-026-04133-y},
  url = {https://europepmc.org/article/MED/42967982},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Median effective infusion rate (ED50) of continuous cisatracurium for preserving interpretable TceMEP signals during intraspinal tumor resection: a prospective up-and-down sequential allocation study.
AU  - Siyi Yan
AU  - Mengzhuo Guo
AU  - Xin Wen
AU  - Zhibin He
PY  - 2026
DA  - 2026/08/05
JO  - BMC anesthesiology
DO  - 10.1186/s12871-026-04133-y
UR  - https://europepmc.org/article/MED/42967982
AB  - Background  Intraoperative neurophysiological monitoring (IONM), particularly transcranial electrical stimulation motor evoked potentials (TceMEP), plays a crucial role in preserving motor function during intraspinal tumor resection. However, neuromuscular blocking agents (NMBAs) may attenuate TceMEP signals and complicate reliable monitoring. Partial neuromuscular blockade (pNMB) through continuous NMBA infusion may help balance interpretable TceMEP monitoring with acceptable surgical conditions.Objective  This study aimed to evaluate the interpretability of TceMEP signals during continuous cisatracurium infusion and thereby estimate the median effective infusion rate (ED50) associated with preservation of interpretable TceMEP signals during intraspinal tumor resection.Methods  Twenty-seven patients undergoing elective intraspinal tumor resection with TceMEP monitoring were enrolled in this prospective, single-center, open-label, sequential dose-finding study using Dixon's up-and-down method. After a standard intubation dose of cisatracurium, continuous infusion was started at 1.0 µg/(kg·min). TceMEP signal interpretability was used as the binary response variable for sequential allocation. A neurophysiologist blinded to the infusion rate classified the signals as interpretable or uninterpretable; the anesthesiology team was not blinded because dose adjustment was required by the sequential design. The infusion rate for each subsequent patient was increased or decreased by a factor of 1.2 according to the response in the preceding patient. ED50 and its 95% confidence interval (CI) were estimated using Dixon's method.Results  The estimated ED50 of continuous cisatracurium infusion associated with preservation of interpretable TceMEP signals was 1.65 µg/(kg·min) (95% CI, 1.52-1.79 µg/(kg·min)). No clinically significant patient movement or serious infusion-related adverse events were observed during the study.Conclusion  In patients undergoing intraspinal tumor resection with TceMEP monitoring, the median effective infusion rate of continuous cisatracurium associated with preservation of interpretable TceMEP signals was 1.65 µg/(kg·min). This value should be interpreted as an ED50 estimate rather than a recommended maximum acceptable infusion rate.Trial registration  Chinese Clinical Trial Registry, ChiCTR2200057610. Registered on March 15, 2022, before enrollment of the first participant.
SN  - 1471-2253
ER  -