Anesthesia and intraoperative neurophysiological spinal cord monitoring

Abstract

Purpose of reviewWe will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery. Recent findingsIn recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist. SummarySafety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.

Comparing Motor-Evoked Potential Characteristics of NEedle versus suRFACE Recording Electrodes during Spinal Cord Monitoring—The NERFACE Study Part I

“…Anesthetic management was at the discretion of the responsible anesthesiologist and in keeping with the departmental protocols. In brief, anesthesia was achieved and maintained with infusions of propofol with either remifentanil or sufentanil [ 15 ]. Propofol administration was titrated to achieve a bispectral index (Medtronic, Ireland) of 40–60 (representing adequate but not excessive depth of anesthesia).…”

Multimodal Analgesia and Intraoperative Neuromonitoring

“…It is well-recognized that many anesthetic agents degrade intraoperative evoked potential signals, particularly in pathways that involve multiple synapses, and that this can compromise the quality of monitoring. 1 As such, transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs), which are among the most commonly used neuromonitoring modalities, are at particular risk for signal degradation. With increasing interest in the use of multimodal analgesia, in addition to considering anesthetic needs that are unique to the surgical procedure and patientspecific comorbidities, 2 anesthesiologists must also understand the potential impact of adjunctive anesthetic and analgesic agents on neuromonitoring to facilitate the highfidelity signal acquisition.…”

“…Such monitoring allows interventions (both surgical and anesthetic) that can potentially prevent permanent iatrogenic neurological injury. It is well-recognized that many anesthetic agents degrade intraoperative evoked potential signals, particularly in pathways that involve multiple synapses, and that this can compromise the quality of monitoring 1. As such, transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs), which are among the most commonly used neuromonitoring modalities, are at particular risk for signal degradation.…”

Editorial: Neuroanaesthesiology editorial

“…One of the main goals of intraoperative neuromonitoring (IONM) is to detect impending surgery-associated neuronal dysfunction at a stage when corrective measures can still be taken to prevent that dysfunction from becoming permanent. Sahinovic et al [12] focus on IONM for spinal procedures. The warning signs used to detect impending injury can be difficult to interpret, as they can also be caused or exacerbated by a variety of factors under the control of the anaesthesiologist such as choice of drugs, drug doses and physiological homeostasis.…”

“…Sahinovic et al . [12] focus on IONM for spinal procedures. The warning signs used to detect impending injury can be difficult to interpret, as they can also be caused or exacerbated by a variety of factors under the control of the anaesthesiologist such as choice of drugs, drug doses and physiological homeostasis.…”