{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:38:47Z","timestamp":1790609927274,"version":"4.1.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003We previously reported that normalization of motor evoked potential (MEP) monitoring amplitude by compound muscle action potential (CMAP) after peripheral nerve stimulation prevented the expression of anesthetic fade (AF), suggesting that AF might be due to reduced synaptic transfer in the neuromuscular junction.<\/jats:p><jats:p>\n          Methods\u2003We calculated the time at which AF began for each of craniotomy and spinal cord surgery, and examined whether AF was avoided by CMAP after peripheral nerve stimulation normalization in each. Similar studies were also made with respect to the upper and lower limb muscles.<\/jats:p><jats:p>\n          Results\u2003AF was observed in surgery lasting 160\u2009minutes for craniotomy and 260\u2009minutes or more for spinal surgery, and 195\u2009minutes in the upper limb muscles and 135\u2009minutes in the lower limb muscles. In all the series, AF could be avoided by CMAP after peripheral nerve stimulation normalization.<\/jats:p><jats:p>\n          Conclusion\u2003AF of MEP occurred in both craniotomy and spinal cord surgery, and it was also corrected by CMAP after peripheral nerve stimulation. AF is considered to be mainly due to a decrease in synaptic transfer of the neuromuscular junction due to the accumulation of propofol because of the avoidance by CMAP normalization. However, it may be partially due to a decrease in the excitability of pyramidal tracts and \u03b1-motor neurons, because AF occurred earlier in the lower limb muscles than in the upper limb muscles.<\/jats:p>","DOI":"10.1055\/a-2103-7381","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T23:36:11Z","timestamp":1685576171000},"page":"451-456","source":"Crossref","is-referenced-by-count":3,"title":["Anesthetic Fade in Intraoperative Transcranial Motor Evoked Potential Monitoring Is Mainly due to Decreased Synaptic Transmission at the Neuromuscular Junction by Propofol Accumulation"],"prefix":"10.1055","volume":"85","author":[{"given":"Satoshi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saitama Medical Center, Kawagoe, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Tomio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Honjo Neurosurgery & Spinal Surgery Clinic, Honjo, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misuzu","family":"Osaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsunemasa","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norio","family":"Akao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terutaka","family":"Nishimatsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1113\/jphysiol.1994.sp020435","article-title":"Transcranial electrical stimulation of the motor cortex in man: further evidence for the site of activation","volume":"481","author":"J Rothwell","year":"1994","journal-title":"J Physiol"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1097\/00006123-199712000-00017","article-title":"The role of motor evoked potentials during surgery for intramedullary spinal cord tumors","volume":"41","author":"N Morota","year":"1997","journal-title":"Neurosurgery"},{"issue":"05","key":"ref3","first-page":"1075","article-title":"Transcranial electrical motor evoked potential monitoring for brain tumor resection","volume":"48","author":"H H 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