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. . . . . Keywords Intraoperative neuromonitoring Anesthesia Optimization Somatosensory-evoked potential Motor-evoked potential Homeostasis Introduction downstream costs . For IONM to add value, it is therefore important to consistently achieve high-quality integration of Intraoperative neuromonitoring (IONM) is dependent on reli- IONM into perioperative care.
Current Anesthesiology Reports – Springer Journals
Published: Jun 2, 2018
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