Causal modeling to estimate sensitivity and specificity of a test when prevalence changes

The suppressive effect of the halogenated inhalation anesthesia on cortical somatosensory evoked potentials (cSSEPs) has been well documented. Less studied and appreciated is the effect of nitrous oxide often with a narcotic as an alternative to a potent agent for spinal cord monitoring. This study sought to define more clearly the influence of nitrous oxide on cSSEPs elicited to posterior tibial nerve stimulation. A secondary purpose was to demonstrate the advantage of a total intravenous propofol anesthesia in facilitating uncompromised large-amplitude cSSEPs. Fifty adult patients undergoing anterior cervical discectomy served as the study sample. Brainstem and cortical posterior tibial nerve SSEPs were recorded under two independent anesthesia conditions, namely, nitrous oxide and propofol. Results demonstrated a significant amplitude reduction and latency prolongation with the nitrous oxide versus propofol protocol. cSSEP amplitude with propofol was, on the average, approximately two times larger than that with nitrous oxide. Based on these findings, the use of nitrous-oxide anesthesia is not recommended when limited to monitoring cSSEPs that are already amplitude compromised secondary to existing spinal cord disease.