Anaes SAQs · Neuroanaesthesia
Neuromonitoring EEG and evoked potentials
Final-examination SAQ for neuromonitoring-eeg-evoked-potentials.
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Prompt
Outline how you would provide anaesthesia for multilevel scoliosis surgery with SSEP and MEP monitoring, including drug choices, neuromuscular blockade strategy, and your response to a sudden 60% fall in MEP amplitude.
Model answer
Technique (5). Propofol–opioid TIVA per the MEP consensus (preferred maintenance, propofol titrated to the lowest dose that maintains depth); avoid N2O; minimise volatiles; arterial line; stable MAP/temp/CO2/Hb.
[4]NMB (3). Intubation only; confirm TOF recovery before MEPs (ongoing NMB incompatible with myogenic MEPs — taught rule); bite block.
[4]Signal loss (7). Inform surgeon; raise MAP; check leads/NMB/ABG; reduce confounders; consider wake-up test/surgical pause — the ISCI care-pathway response.
[5]References2ShowHide
- [4]Walker CT, Kim HJ, Park P, et al. Neuroanesthesia Guidelines for Optimizing Transcranial Motor Evoked Potential Neuromonitoring During Deformity and Complex Spinal Surgery: A Delphi Consensus Study. Spine, 2020.PMID 32539292
- [5]Fehlings MG, Alvi MA, Evaniew N, et al. A Clinical Practice Guideline for Prevention, Diagnosis and Management of Intraoperative Spinal Cord Injury: Recommendations for Use of Intraoperative Neuromonitoring and for the Use of Preoperative and Intraoperative Protocols for Patients Undergoing Spine Surgery. Global Spine Journal, 2024.PMID 38526921