The Role of Desflurane in the Functional Outcomes Among Spinal Cord Injury Patients Undergoing Upper Extremity Nerve Transfer Procedures

Background and objective While several experimental studies have demonstrated the neuroprotective role of volatile anesthetics after spinal cord injury (SCI), the impact of volatile anesthetics on improving neurologic outcomes in spinal cord-injured patients is not known. Hence, this study aimed to examine the impact of volatile anesthetics on functional outcomes of chronic cervical SCI patients undergoing peripheral nerve transfer procedures. Methods We conducted a retrospective analysis involving adult patients with cervical SCI and upper extremity paralysis undergoing nerve transfer procedures between September 1, 2015, and January 31, 2019. The principal outcome measured was the motor strength of the reinnervated muscle targets assessed per the Medical Research Council (MRC) scale graded from 0 to 5. Secondary outcomes included Disabilities of Arm, Shoulder, and Hand (DASH); Sollerman Hand Function Test (SHFT); and Michigan Hand Questionnaire (MHQ) scores. Univariate analysis and logistic regression were performed to examine the association between the volatile anesthetics (sevoflurane, desflurane) used during the nerve transfer surgery with the improvement in muscle strength examined up to 48 months postoperatively. Results A total of 13 tetraplegic patients with a mean age of 39.2 ± 15.9 years were included in this study. We found that the desflurane group (n=22 muscles) had greater median motor strength than the sevoflurane group (n=60 muscles) towards the final follow-up when the desflurane group had median motor strength of 3 [interquartile range (IQR): 1-4] and sevoflurane group had a median motor strength of 1 (IQR: 0-2.25); p=0.014. However, there was no statistically significant difference between the two groups in the DASH, SHFT, and MHQ scores. Logistic regression analysis showed that type of nerve transfer and preop AIS (ASIA Impairment Scale) grade were significantly associated with higher odds of improvement of motor power by at least 2 grades. Conclusions Our preliminary data show an association between desflurane use and improved motor strength in SCI patients undergoing peripheral nerve transfers. The data suggest that volatile anesthetic conditioning-induced protection observed in preclinical studies may also exist in SCI patients. This will need to be validated in a larger sample size. Examining the therapeutic window, and identifying the molecular mechanisms underlying volatile anesthetic conditioning-induced protection are warranted to aid future translational studies.