scholarly journals The influence of anaesthesia on intraoperative neuromonitoring changes in high-risk spinal surgery

2017 ◽  
Vol 04 (03) ◽  
pp. 159-166
Author(s):  
Nathan Royan ◽  
Nancy Lu ◽  
Pirjo Manninen ◽  
Lakshmikumar Venkatraghavan
Keyword(s):  
High Risk ◽  
Spinal Surgery ◽  
Statistical Difference ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Intraoperative Neuromonitoring ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Surgical Interventions ◽  
Neurological Outcomes

Abstract Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (<0.5 minimum alveolar concentration [MAC]) was used in 85% BA cases. Intraoperative neuromonitoring changes occurred in 11.8% (18/152) of cases. There was no statistical difference in the incidence of monitoring changes between BA (78%) and TIVA (22%) groups (P = 0.197). Anaesthetic or surgical interventions were performed in 12 patients, with a resolution of changes in 50% (P = 0.455). All 5 patients with persistent MEP changes had worsening of existing neurological deficits postoperatively; 8 had transient MEP changes, and 2 experienced worsening of existing neurological deficits. Conclusions: We found that intraoperative neurophysiological monitoring can be performed with both BA (MAC <0.5) and TIVA in high-risk spinal surgery with no statistical difference in the incidence of intraoperative monitoring changes.

Effects of Preoperative Motor Status on Intraoperative Motor-Evoked Potential Monitoring for High-Risk Spinal Surgery

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kazuyoshi Kobayashi ◽  
Shiro Imagama ◽  
Go Yoshida ◽  
Muneharu Ando ◽  
Shigenori Kawabata ◽  
...  
Keyword(s):  
High Risk ◽  
Spinal Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

Neuroanesthesia Guidelines for Optimizing Transcranial Motor Evoked Potential Neuromonitoring During Deformity and Complex Spinal Surgery

Spine ◽  
2020 ◽  
Vol 45 (13) ◽  
pp. 911-920
Author(s):  
Corey T. Walker ◽  
Han Jo Kim ◽  
Paul Park ◽  
Lawrence G. Lenke ◽  
Mark A. Weller ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Transcranial Motor Evoked Potential

Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature

2009 ◽  
Vol 27 (4) ◽  
pp. E7 ◽  
Author(s):  
Anthony C. Wang ◽  
Khoi D. Than ◽  
Arnold B. Etame ◽  
Frank La Marca ◽  
Paul Park
Keyword(s):  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Neurological Injury ◽  
Neurophysiological Monitoring ◽  
Intravenous Anesthesia ◽  
Inhalational Anesthetics ◽  
Anesthetic Agents ◽  
Evoked Potential Monitoring ◽  
The Impact

Object Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential. Methods A literature search of the National Library of Medicine database was conducted to identify articles pertaining to anesthesia and TcMEP monitoring during spine surgery. Twenty studies were selected and reviewed. Results Inhalational anesthetics and neuromuscular blockade have been shown to limit the ability of TcMEP monitoring to detect significant changes. Hypothermia can also negatively affect monitoring. Opioids, however, have little influence on TcMEPs. Total intravenous anesthesia regimens can minimize the need for inhalational anesthetics. Conclusions In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.

Feasibility of intraoperative motor-evoked potential monitoring for skull base tumors with a high risk of postoperative motor deterioration

2011 ◽  
Vol 153 (6) ◽  
pp. 1191-1200 ◽  
Author(s):  
Kimiaki Hashiguchi ◽  
Takato Morioka ◽  
Fumiaki Yoshida ◽  
Koji Yoshimoto ◽  
Tadahisa Shono ◽  
...  
Keyword(s):  
High Risk ◽  
Skull Base ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Skull Base Tumors ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

scholarly journals Motor Evoked Potential (MEP) for the Intra-operative Monitoring of Motor Function( Functional Neurophysiological Monitoring for Neurosurgery)

2008 ◽  
Vol 17 (1) ◽  
pp. 13-20
Author(s):  
Takamitsu Yamamoto ◽  
Katunori Shijo ◽  
Toshikazu Kano ◽  
Takafumi Nagaoka ◽  
Kazutaka Kobayashi ◽  
...  
Keyword(s):  
Motor Function ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Neurophysiological Monitoring ◽  
Special Issue ◽  
Operative Monitoring

Cervical decompression and reconstruction without intraoperative neurophysiological monitoring

2012 ◽  
Vol 16 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Vincent C. Traynelis ◽  
Kingsley O. Abode-Iyamah ◽  
Katie M. Leick ◽  
Sarah M. Bender ◽  
Jeremy D. W. Greenlee
Keyword(s):  
Cervical Spine ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Lower Extremities ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Upper And Lower Extremities ◽  
Evoked Potential Monitoring ◽  
Spine Disease ◽  
Potential Monitoring

Object The primary goal of this study was to review the immediate postoperative neurological function in patients surgically treated for symptomatic cervical spine disease without intraoperative neurophysiological monitoring. The secondary goal was to assess the economic impact of intraoperative monitoring (IOM) in this patient population. Methods This study is a retrospective review of 720 consecutively treated patients who underwent cervical spine procedures. The patients were identified and the data were collected by individuals who were not involved in their care. Results A total of 1534 cervical spine levels were treated in 720 patients using anterior, posterior, and combined (360°) approaches. Myelopathy was present preoperatively in 308 patients. There were 185 patients with increased signal intensity within the spinal cord on preoperative T2-weighted MR images, of whom 43 patients had no clinical evidence of myelopathy. Three patients (0.4%) exhibited a new neurological deficit postoperatively. Of these patients, 1 had a preoperative diagnosis of radiculopathy, while the other 2 were treated for myelopathy. The new postoperative deficits completely resolved in all 3 patients and did not require additional treatment. The Current Procedural Terminology (CPT) codes for IOM during cervical decompression include 95925 and 95926 for somatosensory evoked potential monitoring of the upper and lower extremities, respectively, as well as 95928 and 95929 for motor evoked potential monitoring of the upper and lower extremities. In addition to the charge for the baseline [monitoring] study, patients are charged hourly for ongoing electrophysiology testing and monitoring using the CPT code 95920. Based on these codes and assuming an average of 4 hours of monitoring time per surgical case, the savings realized in this group of patients was estimated to be $1,024,754. Conclusions With the continuing increase in health care costs, it is our responsibility as providers to minimize expenses when possible. This should be accomplished without compromising the quality of care to patients. This study demonstrates that decompression and reconstruction for symptomatic cervical spine disease without IOM may reduce the cost of treatment without adversely impacting patient safety.

scholarly journals Intraoperative Motor-Evoked Potential Disappearance versus Amplitude-Decrement Alarm Criteria During Cervical Spinal Surgery: A Long-Term Prognosis

2017 ◽  
Vol 13 (1) ◽  
pp. 38 ◽  
Author(s):  
Dong-Gun Kim ◽  
Young-Doo Choi ◽  
Seung-Hyun Jin ◽  
Chi Heon Kim ◽  
Kwang-Woo Lee ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Versus Amplitude ◽  
Long Term Prognosis
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