Which anesthetic agents are most compatible with myogenic MEPs?

The choice of anesthetic agents that are most compatible with myogenic motor evoked potentials (MEPs) is primarily based on how these agents affect neuromuscular transmission and muscle activity. Propofol and opioids are considered the most compatible because they generally have minimal interference with the cortical and spinal pathways involved in generating MEPs when used at appropriate concentrations.

Propofol, as an intravenous anesthetic, has a rapid onset and offset, allowing for better control over the anesthetic depth. It provides sedation without significantly inhibiting the motor cortex’s ability to generate responses necessary for accurate MEP measurement. Opioids can provide analgesia with less impact on motor responses when compared to inhaled anesthetics or certain other agents, thereby preserving the integrity of motor functions during intraoperative monitoring.

In contrast, halogenated gases typically have a depressive effect on the central nervous system and can obscure or weaken MEP responses, making them less suitable for monitoring purposes. Nitrous oxide, while providing some degree of analgesia, has also been shown to have a more substantial impact on MEPs, leading to diminished responses. Similarly, local anesthetics can effectively block nerve transmission and reduce the muscle response needed for MEP assessment, rendering them incompatible for