Optimizing Intraoperative Neuromonitoring: Anesthetic
Considerations

Rabai, Ferenc; Mohamed, Basma; Seubert, Christoph N.

doi:10.1007/s40140-018-0281-6

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…Striking a balance between achieving adequate multimodal analgesia and IONM compatibility can be challenging, as pharmacological agents administered at an effective analgesic dose may, in fact, preclude adequate signal quality. However, many of the nonopioid analgesics considered in this review could potentially reduce cortical arousal through their antinociceptive properties, and could, in turn, provide a beneficial effect for IONM signal acquisition by lowering the pharmacological requirement for hypnotic agents 2,40. Accordingly, while the current evidence does not allow a definitive recommendation for or against a specific multimodal analgesic intervention in the setting of IONM, it is evident that the effects of any pharmacological agent on IONM would be considerably dependent on dosing regimens, and that these effects are likely exaggerated in patients with pre-existing comorbidities.…”

Section: Discussionmentioning

confidence: 92%

“…However, many of the nonopioid analgesics considered in this review could potentially reduce cortical arousal through their antinociceptive properties, and could, in turn, provide a beneficial effect for IONM signal acquisition by lowering the pharmacological requirement for hypnotic agents. 2,40 Accordingly, while the current evidence does not allow a definitive recommendation for or against a specific multimodal analgesic intervention in the setting of IONM, it is evident that the effects of any pharmacological agent on IONM would be considerably dependent on dosing regimens, and that these effects are likely exaggerated in patients with pre-existing comorbidities. Thus, clinicians should understand the limitation of the available evidence to date, interpret this evidence with caution, and make clinical decisions on an individualized basis as it pertains to the integration of multimodal analgesics in settings where IONM is required.…”

Section: Discussionmentioning

confidence: 99%

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Multimodal Analgesia and Intraoperative Neuromonitoring

Bebawy

Hemmer

2023

Journal of Neurosurgical Anesthesiology

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Intraoperative neuromonitoring has been a valuable tool for ensuring the functional integrity of vital neural structures by providing real-time feedback to the operative team during procedures where neurological structures are at risk. Commonly used intravenous and inhaled anesthetic drugs are known to affect waveform parameters measured with various intraoperative neuromonitoring modalities. While the concept of opioid-sparing multimodal analgesia has gained popularity in recent years, the impact of such a strategy on intraoperative neuromonitoring remains poorly characterized, in contrast to the more well-established concepts and literature regarding the effects of other hypnotic agents on neuromonitoring quality. The purpose of this focused review is to provide an overview of the clinical evidence pertaining to the pharmacological interaction of certain multimodal analgesics with routine intraoperative neuromonitoring modalities.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Multimodal Analgesia and Intraoperative Neuromonitoring

Bebawy

Hemmer

2023

Journal of Neurosurgical Anesthesiology

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“…First, during induction of anesthesia, they facilitate airway management; however, judicious dosing is vital to avoid prolonged drug effect. Further, in some cases the neurophysiologist may request some degree of muscle relaxation to improve SSEP and D-wave monitoring by eliminating spontaneous EMG activity [20].…”

Section: Neuromuscular Blocking Agentsmentioning

confidence: 99%

Anesthesia and intraoperative neurophysiological spinal cord monitoring

Sahinovic¹,

Gadella

Shils

et al. 2021

Current Opinion in Anaesthesiology

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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.

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“…Foreman et al demonstrated how multimodality monitoring, which could include ICC monitoring, provides data to guide the precision management of patients with brain disorders, such as traumatic brain injury [14]. Rabai et al also emphasized that understanding the changes in ICC could enhance the effectiveness of intraoperative neuromonitoring, which is important for the near real time assessment of neuronal pathways during surgery [15]. ICC can also be useful in predicting clinical outcomes in some brain disorders, such as hydrocephalus, cerebral atrophy, intracranial hypertension, traumatic brain injury, and intracranial hematoma.…”

Section: Introductionmentioning

confidence: 99%

Why Intracranial Compliance Is Not Utilized as a Common Practical Tool in Clinical Practice

Gholampour

2023

Biomedicines

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Intracranial compliance (ICC) holds significant potential in neuromonitoring, serving as a diagnostic tool and contributing to the evaluation of treatment outcomes. Despite its comprehensive concept, which allows consideration of changes in both volume and intracranial pressure (ICP), ICC monitoring has not yet established itself as a standard component of medical care, unlike ICP monitoring. This review highlighted that the first challenge is the assessment of ICC values, because of the invasive nature of direct measurement, the time-consuming aspect of non-invasive calculation through computer simulations, and the inability to quantify ICC values in estimation methods. Addressing these challenges is crucial, and the development of a rapid, non-invasive computer simulation method could alleviate obstacles in quantifying ICC. Additionally, this review indicated the second challenge in the clinical application of ICC, which involves the dynamic and time-dependent nature of ICC. This was considered by introducing the concept of time elapsed (TE) in measuring the changes in volume or ICP in the ICC equation (volume change/ICP change). The choice of TE, whether short or long, directly influences the ICC values that must be considered in the clinical application of the ICC. Compensatory responses of the brain exhibit non-monotonic and variable changes in long TE assessments for certain disorders, contrasting with the mono-exponential pattern observed in short TE assessments. Furthermore, the recovery behavior of the brain undergoes changes during the treatment process of various brain disorders when exposed to short and long TE conditions. The review also highlighted differences in ICC values across brain disorders with various strain rates and loading durations on the brain, further emphasizing the dynamic nature of ICC for clinical application. The insight provided in this review may prove valuable to professionals in neurocritical care, neurology, and neurosurgery for standardizing ICC monitoring in practical application related to the diagnosis and evaluation of treatment outcomes in brain disorders.

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Optimizing Intraoperative Neuromonitoring: Anesthetic Considerations

Cited by 7 publications

References 41 publications

Multimodal Analgesia and Intraoperative Neuromonitoring

Multimodal Analgesia and Intraoperative Neuromonitoring

Anesthesia and intraoperative neurophysiological spinal cord monitoring

Why Intracranial Compliance Is Not Utilized as a Common Practical Tool in Clinical Practice

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