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Safety and Troubleshooting

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Intraoperative Monitoring

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Abstract

The understanding of some classical physics laws is necessary for the practice of medicine, more so in the field of clinical neurophysiology. The electrochemical effects of the electric current on the body, and the electromagnetic interaction between the intraoperative monitoring (IOM) system and all other equipment inside the operating room (OR) can directly interfere in the safety of the technique and in the interpretation of the responses. IOM is known to be a very safe procedure if performed within the established parameters. In general, the aspect of most concern is related to direct and indirect effects of the application of electrical current in the body through transcranial electrical stimulation (TES) and direct cortical stimulation (DCS). Other risks related to the use of invasive electrodes or contraindications should not be overlooked. This chapter aims to briefly indicate the interface between the laws of physics and their application in IOM, considering the notion of electrical safety and a practical guide on troubleshooting.

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Abbreviations

DCS :

direct cortical stimulation

DBS :

deep brain stimulator

EEG :

electroencephalography

EMG :

electroneuromyography

EP :

evoked potentials

IOM :

intraoperative monitoring

OR :

operating room

MEP :

motor evoked potential

TES :

transcranial electrical stimulation

SSEP :

somatosensory evoked potential

References

  1. Halliday D, Resnick R, Walker J. Fundamentals of physics. 10th ed. Wiley Publisher; 2013.

    Google Scholar 

  2. Chaves A. Basic physics: electromagnetism. 1st ed. LTC Publisher; 2007.

    Google Scholar 

  3. Bauer W, Westfall GD, Dias H. Physics for university students: electricity and magnetism. 1st ed. AMGH Publisher; 2013.

    Google Scholar 

  4. Dechent D, Emonds T, Stunder D, Schmiedchen K, Kraus T, Driessen S. Direct current electrical injuries: a systematic review of case reports and case series. Burns. 2020;46(2):267–78. https://doi.org/10.1016/j.burns.2018.11.020.

    Article  PubMed  Google Scholar 

  5. Dineen J, Maus DC, Muzyka I, See RB, Cahill DP, Carter BS, Curry WT, Jones PS, Nahed BV, Peterfreund RA, Simon MV. Factors that modify the risk of intraoperative seizures triggered by electrical stimulation during supratentorial functional mapping. Clin Neurophysiol. 2019;130:1058–65.

    Article  PubMed  Google Scholar 

  6. IEC-479-1. Effects of current on human beings and livestock - part 1: general aspects. Publication 479–1 International Electrotechnical Commission; 1994.

    Google Scholar 

  7. Brazilian Standard of ABNT NBR IEC (2012) 60601–1 addendum 1, subsection 3, page 36 and subsection 4.8; 2016.

    Google Scholar 

  8. Brazilian Standard of ABNT NBR IEC 60601-1. 2nd edition. 2010:p.180. https://www.abntcatalogo.com.br/norma.aspx?ID=410528. Accessed on 20 July 2021.

  9. Misulis KE. Basic electronics for clinical neurophysiology. J Clin Neurophysiol. 1989;6(1):41–74.

    Article  CAS  PubMed  Google Scholar 

  10. Kindermann G. Electric Shock. 4th edition of the author. Santa Catarina: LabPlan; 2013.

    Google Scholar 

  11. Burgess RC. Electrical safety. In: Levin KH, Chauvel P, editors. Handbook of clinical neurology, vol. 160. Elsevier; 2019. p. 67–81.

    Google Scholar 

  12. Brazilian Technical Standards Association (ABNT) NBR 5410. Low voltage electrical installations. 2004 (revised version 2008). pp. 30–31.

    Google Scholar 

  13. Macdonald DB, Seidel K, Shils JL. Safety. In: Deletis V, Shils JL, Sala F, Seidel K, editors. Neurophysiology in neurosurgery – a modern approach. Elsevier; 2020. p. 581–96.

    Chapter  Google Scholar 

  14. Gandhi S, Abramov AY. Mechanism of oxidative stress in neurodegeneration (review). OxiMed and Cellular Longevity. 2012:1–11.

    Google Scholar 

  15. Matthew D, Matthew R, Namakkal SR, Victor DU, Jianhua Z. KEAP1 – NRF2 Signalling and autophagy in protection against oxidative and reductive proteotoxicity. Biochem J. 2015;469(3):347–55.

    Article  Google Scholar 

  16. Merril DR, Bikson M, Jeffreys JGR. Electrical stimulation of excitable tissue: design of efficacious and safe protocols. J Neurosci Methods. 2005;141:171–98.

    Article  Google Scholar 

  17. Macdonald DB. Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol. 2002;19(5):416–29.

    Article  PubMed  Google Scholar 

  18. Macdonald DB, Skinner S, Shills J, Yingling C. Intraoperative motor evoked potential monitoring – a position statement by the American Society of Neuropysiological Monitoring. Clin Neurophysiol. 2013;124:2291–316.

    Article  CAS  PubMed  Google Scholar 

  19. Abalkhail TM, Macdonald DB, AlThubaiti I, AlOtaibi FA, Stigsby B, Mokeem AA, AlHamoud IA, Hassounah MI, Baz SM, AlSemari A, AlDhalaan HM, Khan S. Intraoperative direct cortical stimulation motor evoked potentials: stimulus parameter recommendations based on rheobase and chronaxie. Clin Neurophysiol. 2017;128(11):2300–8. https://doi.org/10.1016/j.clinph.2017.09.005. Epub 2017 Sep 28

    Article  PubMed  Google Scholar 

  20. MacDonald DB, Deletis V. Safety issues during surgical monitoring. In: Nuwer MR, editor. Intraoperative monitoring of neural function, Handbook of clinical neurophysiology, vol. 8. Amsterdam: Elsevier; 2008. p. 88298.

    Google Scholar 

  21. Merrit WT, Brinker JA, Beattie C. Pacemaker-mediated tachycardia induced by intraoperative somatosensory evoked potential stimuli. Anesthesiology. 1988;69:766–8.

    Article  Google Scholar 

  22. Schneider R, Machens Q, Bucher M, Raspé C, Heinroth K, Dralle H. Continuous intraoperative monitoring of vagus and recurrent laryngeal nerve function in patients with advanced atrioventricular block (rapid communications). Langenbeck's Arch Surg. 2016;401(4):551–6. https://doi.org/10.1007/s00423-016-1433-0. Epub 2016 Apr 30

    Article  Google Scholar 

  23. Yellin JL, Wiggins CR, Franco AJ, Sankar WN. Safe transcranial electric stimulation motor evoked potential monitoring during spinal fusion in two patients with cochlear implants. J Clin Monit Comput. 2016;30:503–6.

    Article  PubMed  Google Scholar 

  24. Elmqvist R, Senning Ä. Implantable pacemaker for the heart. Proceedings of the second international conference on medical electronics, Paris. Jun 24–27, 1959.

    Google Scholar 

  25. Burgess RC. Filtering of neurophysiologic signals. In: Levin KH, Chauvel P, editors. Handbook of clinical neurology, vol. 160. Elsevier; 2019. p. 51–65.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurophysiology, Stela Clinic, Brasilia, Brazil

    Jose Alberto Nunes Sobrinho

  2. Department of Neurophysiology, Integrated Neuroscience Institute, Goiânia, GO, Brazil

    Monica Nascimento de Melo

  3. Instituto de Ensino e Pesquisa (Research and Educational Institute) of Sírio Libanês Hospital, São Paulo, Brazil

    Silvia Mazzali Verst

  4. Brain Spine Neurofisiologia, Jundiaí, SP, Brazil

    Silvia Mazzali Verst

Authors
  1. Jose Alberto Nunes Sobrinho
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  2. Monica Nascimento de Melo
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  3. Silvia Mazzali Verst
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Editor information

Editors and Affiliations

  1. Instituto de Ensino e Pesquisa (Research and Teaching Institute), Hospital Sírio Libanês, São Paulo, Brazil

    Silvia Mazzali Verst

  2. Neurophisiology Department, Vitoria Apart Hospital, Serra, Espírito Santo, Brazil

    Maria Rufina Barros

  3. Neurosurgery Department, Hospital Sírio Libanês, São Paulo, São Paulo, Brazil

    Marcos Vinicius Calfat Maldaun

Electronic Supplementary Material

Electric field effect near the recording electrodes (induction artifact). Identifying and displacing electric field generating source can minimize and even eliminate noise on the free run EMG. (MOV 1945 kb)

60 Hz artifact in the upper limb SSEP record. (MP4 3325 kb)

SSEP recording after changing the bandpass filters and switching to a non-harmonic stimuli frequency with 60 Hz. (MP4 8438 kb)

Snoring effect on free run EMG due to vocalis muscle. The orotracheal tube cuff was poorly inflated, causing air to escape and the artifact was recorded by the laryngeal electrode. (MP4 7068 kb)

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Nunes Sobrinho, J.A., de Melo, M.N., Verst, S.M. (2022). Safety and Troubleshooting. In: Verst, S.M., Barros, M.R., Maldaun, M.V.C. (eds) Intraoperative Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-95730-8_4

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  • DOI: https://doi.org/10.1007/978-3-030-95730-8_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95729-2

  • Online ISBN: 978-3-030-95730-8

  • eBook Packages: MedicineMedicine (R0)

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