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Optimizing Intraoperative Neuromonitoring: Anesthetic Considerations

  • Neuroanesthesia (D Sharma, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Intraoperative neuromonitoring (IONM) offers near-real-time assessment of neuronal pathways during surgery. Anesthetic regimens and derangements in homeostasis may render IONM ineffective and challenge its clinical utility. We review important anesthetic considerations for optimizing IONM modalities sensitive to these factors including sensory- and motor-evoked potentials.

Recent Findings

Anesthetic management during IONM requires consideration and the balance of multiple competing goals related to depth of anesthesia, patient comorbidities, and surgical requirements. Inhalational anesthetics in higher concentrations unequivocally depress IONM signals and should be used judiciously or avoided altogether in specific cases. The addition of adjuncts such as dexmedetomidine and lidocaine to carefully composed and titrated intravenous anesthetic regimens allows for propofol dose reduction and the optimization of IONM. Hypothermia, cerebral/spinal cord hypoperfusion, and reduced oxygen delivery should be avoided and corrected to maintain homeostasis for optimized neuronal functioning and IONM.

Summary

Optimization of anesthetic management contributes to successful integration of IONM into perioperative care.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0254, USA

    Ferenc Rabai, Basma Mohamed & Christoph N. Seubert

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  1. Ferenc Rabai
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  2. Basma Mohamed
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  3. Christoph N. Seubert
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Correspondence to Christoph N. Seubert.

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Ferenc Rabai, Basma Mohamed, and Christoph N. Seubert declare they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Neuroanesthesia

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Rabai, F., Mohamed, B. & Seubert, C.N. Optimizing Intraoperative Neuromonitoring: Anesthetic Considerations. Curr Anesthesiol Rep 8, 306–317 (2018). https://doi.org/10.1007/s40140-018-0281-6

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  • DOI: https://doi.org/10.1007/s40140-018-0281-6

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