Warning criteria for intraoperative neurophysiologic monitoring

Liu, Quanmeng; Wang, Qinzhou; Liu, Hongen; Wu, William Ka Kei; Chan, Matthew T. V.

doi:10.1097/aco.0000000000000505

Cited by 18 publications

(13 citation statements)

References 44 publications

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“…9 Su uso ha sido mas difundido en cirugía de columna, en la cual, a pesar de resultados favorables, elementos nerviosos pueden dañarse por mecanismos directos (compresión, tracción, laceración sección, avulsión) o indirectos (fenómenos isquémicos por elongación o compresión de la vascularización medular) y generar complicaciones secundarias al tratamiento quirúrgico. [18][19][20] El registro de potenciales evocados (PE) representa la técnica electrofisiológica con mayor capacidad para proporcionar medidas cuantitativas, objetivas y oportunas para la vigilancia de la integridad funcional de ME, raíces nerviosas y adecuación del suministro vascular a estos elementos, 4,9,21 ya que permite el reconocimiento de manera rápida y en tiempo real de cambios funcionales en vías motoras, sensitivas y estructuras nerviosas que las conforman (tractos anteriores y cordones posteriores). 5,[21][22] Evidencia médica sólida de clase I respalda su uso -incluido el registro de potenciales evocados somatosensoriales (PESS) y potenciales evocados motores transcraneales (PEMTc)-, como complemento de diagnóstico confiable, así como método válido para evaluar integridad de ME en entorno perioperatorio de cirugía de columna.…”

Section: Resultsunclassified

Impacto del manejo anestésico en Monitoreo Neurofisiológico Intraoperatorio: Revisión Narrativa

Santos

2022

Arch Neurocien

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Resumen La patología de columna vertebral es de las principales causas de dolor crónico neurogénico y discapacidad en la población general. El monitoreo neurofisiológico intraoperatorio (MNIO) permite vigilar y evaluar la integridad del sistemas motor y sensitivo en procedimientos que ponen en riesgo al sistema nervioso (SN) y evitar complicaciones. Objetivo: Revisión de publicaciones revisadas por pares; identificar y describir las principales técnicas de MNIO y el impacto del manejo anestésico y perioperatorio sobre estas. Métodología: Búsqueda y revisión sistemática y narrativa en idioma inglés y español, en las bases de datos MEDLINE, Scopus y PubMed, utilizando los términos MeSH: " Monitoreo Neurofisiológico Intraoperatorio”; “Anestesia”; “Neuroanestesia”; “Manejo perioperatorio”; “Cirugía de columna”; “Complicaciones”; “Seguridad”. Resultados: Las guías clínicas nacionales e internacionales actuales para cirugía espinal recomiendan el MNIO multimodal en cirugía intracraneal y de columna para evaluar la integridad funcional del SN. Para el éxito del MNIO, es de vital importancia comprender la influencia de los anestésicos y otras variables sobre los registros. Como técnica de elección, se recomienda anestesia total intravenosa (ATIV) con propofol para un mejor registro de los PEM y los PESS (NE: 2C). Conclusiones Es fundamental comprender las bases clínicas de las diferentes técnicas del MNIO e interpretar en forma oportuna alertas y criterios de alarma para obtener mejores resultados quirúrgicos y prevenir lesiónes neurológicas permanentes. El neuroanestesiólogo debe asegurar un adecuado estado de profundidad anestésica, estabilidad hempodinámica y de presión de perfusión cerebromedular, evitando modificaciones que alteren los registros. PALABRAS CLAVE: Anestesia; Neuroanestesia; Monitoreo Neurofisiológico Intraoperatorio; Cirugía de columna; Complicaciones; Seguridad. ¿Qué sabemos acerca de este problema y qué aporta este estudio? A pesar de la amplia difusión y recomendación del uso del Monitoreo Neurofisiológico Intraoperatorio (MNIO) por las guías internacionales, existe poca difusión y comprensión por parte de los anestesiólogos sobre el tipo de técnicas, así como la importancia e impacto del manejo anestésico y perioperatorio sobre el mismo. Este estudio identifica y describe las principales técnicas de MNIO, así como el impacto de los fármacos, variables hemodinámicas, manejo anestésico y perioperatorio sobre el MNIO.

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Section: Resultsunclassified

Impacto del manejo anestésico en Monitoreo Neurofisiológico Intraoperatorio: Revisión Narrativa

Santos

2022

Arch Neurocien

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“…Guidelines suggest that loss of 50 to 100% amplitude of the motor evoked potential amplitude triggers the alarm. 18 Therefore, in our study we had decided to monitor the amplitude of evoked potential, and 80% amplitude loss was set as a warning sign of significant neurologic deficit. The major difference between our study and previously published studies are that we formulated two different regimens of desflurane and propofol combined with dexmedotomidine and compared them to the standard technique in a blinded, placebo-controlled, randomized fashion.…”

Section: Discussionmentioning

confidence: 99%

Effect of Two Anesthetic Regimes with Dexmedetomidine as Adjuvant on Transcranial Electrical Motor Evoked Potentials during Spine Surgery

Mishra

Prabhakar

Kapoor

et al. 2020

Journal of Neuroanaesthesiology and Critical Care

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Background Transcranial motor evoked potential (TcMEP) recording during spinal cord/spinal column surgery is a reliable and valid diagnostic adjunct to assess spinal cord integrity and is recommended if utilized for this purpose. Electrophysiologic monitoring in terms of TcMEP has been proven to be a useful tool in detecting spinal cord dysfunction at the earliest and allows corrective action to be taken before permanent neuronal dysfunction sets in. The quality of intraoperative neuromonitoring is influenced by various factors. Most anesthetics used in clinical practice suppress the evoked potentials. Thus, selecting an appropriate technique is always a challenging task. Materials and Methods Thirty ASA I and II patients scheduled for elective dorsolumbar spine surgery with TcMEP monitoring were recruited in the study. Patients were randomized into three groups: (1) Propofol (group P) 100 to 150 µg/kg/min with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, (2) desflurane (group D) (<0.5 MAC) with dexmedetomidine 0.6 µg/kg/hr and fentanyl 1 µg/kg/hr, and (3)standard group (group S) patients received propofol 100 to 150 µg/kg/min, fentanyl 1 µg/kg/hr along with equal volume of saline (placebo). TcMEP amplitudes were recorded bilaterally from electrodes placed at least in one set of muscles with motor origin rostral and one set of muscle caudal to the spinal level of lesion at different time points. Results Three patients were excluded after allocation; 27 out of 30 patients were analyzed. The demographic and surgical characteristics of patients were comparable. The stimulation voltage needed to elicit the responses in all the three groups was comparable. No difference was observed in brachioradialis muscle amplitudes between the groups at different time points. However, in the right brachioradialis muscle, we found reduced amplitudes at baseline in group D and at 120 minutes in group P. We noticed reduced amplitudes of bilateral brachioradialis muscle in group P at 60 minutes and 90 minutes with respect to the baseline. For lower extremity, we measured amplitudes of TcMEP in tibialis anterior (TA) and did not find any difference in amplitudes between the groups at different time points. Conclusion We observed that the desflurane–dexmedetomidine combination did not hinder TcMEP as compared with both standard and propofol–dexmedetomidine groups. Thus, this combined regime could be used in surgeries requiring motor evoked potential monitoring.

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“…• High rate of false positive alarm and may lead to premature and unnecessary interruption in the surgery so that it was proposed a decrease in limit to peak-to-peak amplitude decrease to 80% to MEP monitoring [76].…”

Section: Limitations Ionm Recordingsmentioning

confidence: 99%

“…• Given time for patients to awake from general anesthesia may be insufficient for an accurate examination leading to anesthesiainduced hemiparesis [76,77].…”

Section: Ionm As An Alternative To Wake Up Testmentioning

confidence: 99%

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Marafona¹,

Machado²

2017

J Anesth Clin Res

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Background: Nowadays, intraoperative evoked potentials are recommended in a variety of procedures but there is still a lack of standard protocols and consensus about warning criteria. Moreover, studies are now being made to fundament its risk-beneficial ratio through recordings' predictive value for short and long term outcomes. Furthermore, wake up test limitations encouraged intraoperative evoked potentials research, a reliable monitoring technology.

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Warning criteria for intraoperative neurophysiologic monitoring

Cited by 18 publications

References 44 publications

Impacto del manejo anestésico en Monitoreo Neurofisiológico Intraoperatorio: Revisión Narrativa

Impacto del manejo anestésico en Monitoreo Neurofisiológico Intraoperatorio: Revisión Narrativa

Effect of Two Anesthetic Regimes with Dexmedetomidine as Adjuvant on Transcranial Electrical Motor Evoked Potentials during Spine Surgery

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

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