There is limited research on the impact of lidocaine on neuromonitoring within contemporary anesthesia practices, but it appears that lidocaine can be used as part of IV anesthesia without disrupting monitoring signals. However, two studies reported that when lidocaine was combined with nitrous oxide (N2O), there was a noticeable reduction in the amplitude and an increase in the latency of somatosensory evoked potentials (SSEPs). Although high doses of lidocaine can provoke seizures, low doses act as anticonvulsants and have been utilized to manage status epilepticus effectively.
| Agent | SSEPs | MEPs | EEG |
|---|---|---|---|
| Barbiturates (thiopental, pentobarbital) | Modest, transient changes; recordable even at burst-suppression doses | Highly sensitive to most barbiturates; TIVA with methohexital can still allow monitoring | Low-dose methohexital enhances activity, aiding identification of seizure foci |
| Benzodiazepines (midazolam, premedication doses) | No impact | No impact | Slows activity; anticonvulsant, usually without burst suppression or silence |
| Ketamine | Increases cortical amplitude; counteracts N2O depression | Increases amplitude, but large boluses reduce amplitude | Increases both amplitude and frequency; can trigger seizures in epilepsy |
| Etomidate | Enhances cortical amplitude throughout the infusion | Muscle responses unchanged | Low doses can induce seizure activity in epilepsy, useful for ECoG |
| Dexmedetomidine | Minimal effect | Generally avoided; higher doses may cause loss of recordings | Slow-wave-sleep pattern; little to no impact on ECoG |
| Opioids (remifentanil, fentanyl, sufentanil) | Slight dose-dependent depression; recordable at very high doses | Slight dose-dependent depression; recordable at very high doses | High-amplitude slow waves |
| Lidocaine | Usable without disrupting signals; reduced amplitude and increased latency when combined with N2O | — | High doses can provoke seizures; low doses are anticonvulsant |
