Intraoperative Neuromonitoring: Principles and Considerations for Perioperative Nurses

Abstract

Intraoperative neuromonitoring (IONM) is a method used to warn the surgeon of impending neurological damage while it can still be corrected, ideally preventing a permanent neurological deficit in the surgical patient. It was originally used in neurosurgery, but now also applies to other surgical specialties. Comprehensive monitoring of a patient's neurological status requires using a variety of approaches. The IONM tests most frequently used in the OR are somatosensory evoked potentials; transcranial electrical motor evoked potentials; electromyography, including cranial nerve monitoring; and electroencephalography. With its increased use during a variety of operative and other invasive procedures, most perioperative nurses will be exposed to IONM at some point in their careers. This article provides perioperative nurses with a basic understanding of IONM, including the framework, purpose, associated terminology, and nursing implications.

Anterior Cervical Discectomy and Fusion: A Surgical Intervention for Treating Cervical Disc Disease

“…Whether the surgeon uses an anterior or posterior approach, the surgical team typically uses intraoperative neuromonitoring for all cervical and thoracic spine surgery 17 . Evoked potentials are recorded electrical activity after repetitive stimulation.…”

Perioperative Nursing Care of the Patient Undergoing a Cochlear Implant Procedure

“…When a surgeon requests intraoperative neuromonitoring, the neuromonitoring technician should insert the electrodes into the patient's facial muscles before the RN circulator performs the surgical skin antisepsis. 18 The RN circulator applies adhesive drapes to keep the patient's hair out of the surgical field. The surgeon removes any hair from the operative site with electric or batterypowered clippers.…”

“…The monitoring electrodes are connected to the neuromonitoring machine to monitor the patient’s facial nerve function during the procedure. When a surgeon requests intraoperative neuromonitoring, the neuromonitoring technician should insert the electrodes into the patient’s facial muscles before the RN circulator performs the surgical skin antisepsis 18 …”

A Nanometer Resolution Wearable Wireless Medical Device for Non Invasive Intracranial Pressure Monitoring

“…Innovation applied to neurology and neurosurgery advanced in the 1970s with the invention of computed tomography (CT) scans and magnetic resonance imaging (MRI) [1]- [5]. Many other instruments have been developed since then, incorporating new technologies to medical care, such as catheters for cerebral metabolic analysis [6], stereotactic surgical systems [7], [8], intraoperative neurophysiological monitoring [9], [10], (e-mail: rodrigo.andrade@brain4.care; helder.oshiro@brain4.care; caio.miyazaki@brain4.care; marcos.morais@brain4.care; rodrigo.brunelli@brain4.care) C.Y. Hayashi is with Research Departament of Braincare Desenvolvimento e Inovacao Tecnologica S.A., Sao Paulo, SP, Brazil.…”