What Can We Learn From Two Consecutive Cases? Droperidol May Abolish TcMEPs.

Droperidol is a D2 receptor antagonist currently used in Europe for preventing postoperative nausea and vomiting. It was used to perform neurolept anaesthesia in combination with fentanyl until a Food and Drug Administration (FDA) 'black box' warning restricted its use due to cardiovascular side effects in 2001. There is no literature regarding the effects of droperidol on transcranial motor evoked potentials (TcMEPs) elicited by electrical stimulation. Our aim was to report two cases of spine surgery in which TcMEPs were lost due to droperidol administration. We report the cases of a 4-year-old male with scoliosis undergoing correction and a 58-year-old woman with metastasis on the D8 vertebrae undergoing kyphosis correction. Intraoperative neurophysiological monitoring was achieved through TcMEPs and somatosensory evoked potentials (SEPs). Intraoperative neurophysiological monitoring (IONM) showed a temporal loss of TcMEPs without SEPs changes coinciding with the administration of droperidol. TcMEP stimulation parameters were changed to double train of pulses, with the aim to elicit them, obtaining responses. Five minutes after droperidol administration, TcMEPs were equal to those at baseline. Droperidol used as prophylaxis for postoperative nausea abolishes TcMEPs. Changing stimulation parameters to double train of pulses, it allows to bypass droperidol central action, achieving monitorable TcMEPs.