Bite injuries caused by transcranial electrical stimulation motor-evoked potentials’ monitoring: incidence, associated factors, and clinical course

• Published in: Journal of anesthesia 2018-12, Vol.32 (6), p.844-849
• Main Authors: Yata, Sachiko, Ida, Mitsuru, Shimotsuji, Hiroko, Nakagawa, Yosuke, Ueda, Nobuhiro, Takatani, Tsunenori, Shigematsu, Hideki, Motoyama, Yasushi, Nakase, Hiroyuki, Kirita, Tadaaki, Kawaguchi, Masahiko
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesiology; Bites, Human - prevention & control; Brain stimulation; Causes of; Complications and side effects; Critical Care Medicine; Drug therapy; Electric Stimulation; Emergency Medicine; Evoked Potentials, Motor - physiology; Female; Humans; Incidence; Injuries; Intensive; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative; Monitoring, Physiologic; Original Article; Pain Medicine; Transcranial Direct Current Stimulation - methods
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-018-2562-0

Purpose The incidence of bite injuries associated with transcranial electrical stimulation motor-evoked potentials monitoring reportedly ranges from 0.13 to 0.19%. However, in clinical practice, bite injuries appear to occur more frequently than previously reported. Our aim was to identify the incidence of and perioperative risk factors associated with bite injuries caused by transcranial electrical stimulation motor-evoked potential monitoring. Methods Patients who underwent elective surgery with transcranial electrical stimulation motor-evoked potential monitoring at a single tertiary hospital in Japan between June 2017 and December 2017 were included in this study. All patients were assessed by oral surgeons preoperatively and postoperatively. The associated factors with bite injuries were explored by the univariate analysis. Results 12 of 186 patients experienced 13 bite injuries, including three lip, six oral mucosa, and four tongue injuries. No patient required suture repair. 11 of 12 patients had uneventful postoperative courses and were cured within 12 postoperative days. One patient with a tongue ulcer and a hematoma had difficulty in oral intake and persistent dysgeusia. Patient severe movement during transcranial electrical stimulation motor-evoked potential monitoring was associated with bite injuries ( p  = 0.03). Conclusions The incidence of bite injuries assessed by oral surgeons was 6.5% in patients with transcranial electrical stimulation motor-evoked potential monitoring, and the patients with severe movement during the monitoring tended to incur bite injuries. In rare cases, transcranial electrical stimulation motor-evoked potential monitoring may cause difficulty in oral intake and dysgeusia.