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Peer-reviewedCC BYDrug Design, Development and Therapy

Effect of Two Desflurane Concentration-Based Anesthetic Strategies on Flash Visual Evoked Potential Monitoring During Spine Surgery: A Randomized Superiority Trial

  • Wang J1
  • Lin X1
  • Yang X2
  • Qiao H2
  • Han R1
  • Ma J1
  1. 1Department of Anesthesiology
  2. 2Department of Electrophysiology
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Abstract

Jing Wang,1,&ast; Xiaowan Lin,1,&ast; Xiaocui Yang,2 Hui Qiao,2 Ruquan Han,1 Jiajia Ma1 1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Electrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiajia Ma, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-10-59776658, Email [email protected] Ruquan Han, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-10-59976656, Email [email protected]: Intraoperative flash visual-evoked potential (FVEP) monitoring is valuable for assessing visual function. However, it can be influenced by inhaled anesthetics. This trial aimed to compare two desflurane concentration-based anesthetic strategies for FVEP monitoring.Patients and Methods: Seventy patients undergoing elective spinal surgery were enrolled in this prospective, randomized controlled, superiority trial and randomized 1:1 to either the desflurane-based balanced anesthesia group (BA group), receiving 0.5 MAC desflurane with propofol and remifentanil, or the desflurane-dominant inhalational anesthesia group (IA group), receiving 0.7– 1.0 MAC desflurane with remifentanil. Baseline measurement in both groups was obtained 30 min after induction (T1) under total intravenous anesthesia (TIVA). The primary outcome was N75-P100 amplitude measured 60 min after induction (T2). Secondary outcomes included decline rates of N75-P100 and P100-N145 amplitudes from T1 to T2.Results: Among 69 analyzed patients (35 in the BA group and 34 in the IA group), the N75-P100 amplitude of BA group was significantly superior (10.1 [5.2] μV vs 6.3 [2.7] μV; δ = 0.47 μV; mean difference = 3.81 μV, 95% CI: 1.81 to 5.80 (μV); P for superiority < 0.001). The median [IQR] decline rates of the N75-P100 amplitude (0.16 [− 0.04 to 0.25] vs 0.49 [0.40 to 0.57], P < 0.001) and the P100-N145 amplitude (0.08 [− 0.11 to 0.20] vs 0.44 [0.36 to 0.56], P < 0.001) from T1 to T2 were significantly higher in the IA group than in the BA group.Conclusion: Desflurane-based balanced anesthesia is superior to desflurane-dominant inhalational anesthesia for preserving FVEP waveforms. When volatile anesthesia is required, the 0.5 MAC desflurane-based balanced regimen may serve as a viable alternative option for intraoperative FVEP monitoring.Graphical Abstract: A) Infographic step 1: 69 patients, with an icon of three people and a spine illustration. B) Infographic step 2: BA versus IA. BA: 0.5 MAC desflurane plus propofol plus remifentanil. IA: 0.7 to 1.0 MAC desflurane plus remifentanil. Syringe and vial icons appear next to each group. C) Infographic step 3: Better preservation of FVEP amplitude at T2, with a brain illustration. A bar chart shows y axis label, FVEP amplitude, unit not shown and x axis labels, BA and IA, unit not shown; the BA bar is taller than the IA bar. A curved arrow points upward from the bars toward the brain illustration. Bottom text: 0.5 MAC desflurane based balanced anesthesia is a feasible option during intraoperative FVEP monitoring.An infographic of 69 patients comparing BA versus IA anesthesia and FVEP amplitude at T2.Plain Language Summary: Question: Flash visual evoked potential (FVEP) monitoring during spine surgery to help preserve patients’ visual function. Total intravenous anesthesia is widely considered the best anesthesia choice for this monitoring. However, it remains unclear how different concentrations of inhaled anesthetic gas affect FVEP signals. We aimed to find out whether higher or lower levels of desflurane change these FVEP waveforms during spine surgery.Findings: We found 0.5MAC desflurane worked better for preserving FVEP signals than 0.7-1.0 MAC desflurane.Meaning: These findings suggest that 0.5 MAC desflurane combined with a propofol-remifentanil regimen is a feasible anesthetic protocol for intraoperative FVEP monitoring when volatile anesthesia is required.Keywords: flash visual evoked potential, desflurane, spine surgery, superiority trial

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Cite

BibTeXRIS
BibTeX
@article{wang2026effect,
  title = {{Effect of Two Desflurane Concentration-Based Anesthetic Strategies on Flash Visual Evoked Potential Monitoring During Spine Surgery: A Randomized Superiority Trial}},
  author = {Wang J and Lin X and Yang X and Qiao H and Han R and Ma J},
  journal = {Drug Design, Development and Therapy},
  year = {2026},
  month = nov,
  url = {https://www.dovepress.com/effect-of-two-desflurane-concentration-based-anesthetic-strategies-on--peer-reviewed-fulltext-article-DDDT},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Effect of Two Desflurane Concentration-Based Anesthetic Strategies on Flash Visual Evoked Potential Monitoring During Spine Surgery: A Randomized Superiority Trial
AU  - Wang J
AU  - Lin X
AU  - Yang X
AU  - Qiao H
AU  - Han R
AU  - Ma J
PY  - 2026
DA  - 2026/11/08
JO  - Drug Design, Development and Therapy
UR  - https://www.dovepress.com/effect-of-two-desflurane-concentration-based-anesthetic-strategies-on--peer-reviewed-fulltext-article-DDDT
AB  - Jing Wang,1,&ast; Xiaowan Lin,1,&ast; Xiaocui Yang,2 Hui Qiao,2 Ruquan Han,1 Jiajia Ma1 1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Electrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiajia Ma, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-10-59776658, Email [email protected] Ruquan Han, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-10-59976656, Email [email protected]: Intraoperative flash visual-evoked potential (FVEP) monitoring is valuable for assessing visual function. However, it can be influenced by inhaled anesthetics. This trial aimed to compare two desflurane concentration-based anesthetic strategies for FVEP monitoring.Patients and Methods: Seventy patients undergoing elective spinal surgery were enrolled in this prospective, randomized controlled, superiority trial and randomized 1:1 to either the desflurane-based balanced anesthesia group (BA group), receiving 0.5 MAC desflurane with propofol and remifentanil, or the desflurane-dominant inhalational anesthesia group (IA group), receiving 0.7– 1.0 MAC desflurane with remifentanil. Baseline measurement in both groups was obtained 30 min after induction (T1) under total intravenous anesthesia (TIVA). The primary outcome was N75-P100 amplitude measured 60 min after induction (T2). Secondary outcomes included decline rates of N75-P100 and P100-N145 amplitudes from T1 to T2.Results: Among 69 analyzed patients (35 in the BA group and 34 in the IA group), the N75-P100 amplitude of BA group was significantly superior (10.1 [5.2] μV vs 6.3 [2.7] μV; δ = 0.47 μV; mean difference = 3.81 μV, 95% CI: 1.81 to 5.80 (μV); P for superiority < 0.001). The median [IQR] decline rates of the N75-P100 amplitude (0.16 [− 0.04 to 0.25] vs 0.49 [0.40 to 0.57], P < 0.001) and the P100-N145 amplitude (0.08 [− 0.11 to 0.20] vs 0.44 [0.36 to 0.56], P < 0.001) from T1 to T2 were significantly higher in the IA group than in the BA group.Conclusion: Desflurane-based balanced anesthesia is superior to desflurane-dominant inhalational anesthesia for preserving FVEP waveforms. When volatile anesthesia is required, the 0.5 MAC desflurane-based balanced regimen may serve as a viable alternative option for intraoperative FVEP monitoring.Graphical Abstract: A) Infographic step 1: 69 patients, with an icon of three people and a spine illustration. B) Infographic step 2: BA versus IA. BA: 0.5 MAC desflurane plus propofol plus remifentanil. IA: 0.7 to 1.0 MAC desflurane plus remifentanil. Syringe and vial icons appear next to each group. C) Infographic step 3: Better preservation of FVEP amplitude at T2, with a brain illustration. A bar chart shows y axis label, FVEP amplitude, unit not shown and x axis labels, BA and IA, unit not shown; the BA bar is taller than the IA bar. A curved arrow points upward from the bars toward the brain illustration. Bottom text: 0.5 MAC desflurane based balanced anesthesia is a feasible option during intraoperative FVEP monitoring.An infographic of 69 patients comparing BA versus IA anesthesia and FVEP amplitude at T2.Plain Language Summary: Question: Flash visual evoked potential (FVEP) monitoring during spine surgery to help preserve patients’ visual function. Total intravenous anesthesia is widely considered the best anesthesia choice for this monitoring. However, it remains unclear how different concentrations of inhaled anesthetic gas affect FVEP signals. We aimed to find out whether higher or lower levels of desflurane change these FVEP waveforms during spine surgery.Findings: We found 0.5MAC desflurane worked better for preserving FVEP signals than 0.7-1.0 MAC desflurane.Meaning: These findings suggest that 0.5 MAC desflurane combined with a propofol-remifentanil regimen is a feasible anesthetic protocol for intraoperative FVEP monitoring when volatile anesthesia is required.Keywords: flash visual evoked potential, desflurane, spine surgery, superiority trial
SN  - 1177-8881
ER  -