REFERENCES PLEASE POST AT ANESTHESIA STATION

IMPORTANT
1 MacDonald DB (2002) Safety of intraoperative transcranial electrical stimulation motor evoked
potential monitoring. J Clin Neurophysiol 19(5):416-29.
2 Calancie B, Harris W, Brindle GF, Green BA, Landy HJ (2001) Threshold-level repetitive
transcranial electrical stimulation for intraoperative monitoring of central motor conduction.
J Neurosurg 95(2 Suppl):161-8.
3 Zhou HH, Zhu C (2000) Comparison of isoflurane effects on motor evoked potential and F wave.
Anesthesiology 93(1):32-8.

NEUROVISION
4 Pechstein U, Nadstawek J, Zentner J, Schramm J (1998) Isoflurane plus nitrous oxide versus ®
propofol for recording of motor evoked potentials after high frequency repetitive electrical
stimulation. Electroencephalogr Clin Neurophysiol 108(2):175-81.

RECOMMENDATIONS FOR
5 Kawaguchi M, Inoue S, Kakimoto M, Kitaguchi K, Furuya H, Morimoto T, Sakaki T (1998) The
effect of sevoflurane on myogenic motor-evoked potentials induced by single and paired
transcranial electrical stimulation of the motor cortex during nitrous oxide/ketamine/fentanyl
anesthesia. J Neurosurg Anesthesiol 1998 10(3):131-6.
6 Scheufler KM, Zentner J (2002) Total intravenous anesthesia for intraoperative monitoring of
ANESTHESIA, MONITORING, & RECORDING
the motor pathways: an integral view combining clinical and experimental data. J Neurosurg
96(3):571-9.
7 Lotto ML, Banoub M, Schubert A (2004) Effects of anesthetic agents and physiological changes
on intraoperative motor evoked potentials. J Neurosurg Anesthesiol 16(1):32-42.
8 van Dongen EP, ter Beek HT, Schepens MA, Morshuis WJ, Langemeijer HJ, Kalkman CJ,
Boezeman EH (1999) The influence of nitrous oxide to supplement fentanyl/low-dose propofol
anesthesia on transcranial myogenic motor-evoked potentials during thoracic aortic surgery.
J Cardiothorac Vasc Anesth 13(1):30-4.
9 Kunisawa T, Nagata O, Nomura M, Iwasaki H, Ozaki M (2004) A comparison of the absolute
amplitude of motor evoked potentials among groups of patients with various concentrations of
nitrous oxide. J Anesth 18:181-4.
10 Osburn L (2006) A Guide to the Performance of Transcranial Electrical Motor Evoked Potentials.
Part 1. Basic Concepts, Recording Parameters, Special Considerations, and Application. Am J. End
Technology 46:98-158.
11 Zouridakis George, Papanicolaou Andrew C. A Concise Guide to Intraoperative Monitoring. Boca
Raton: CRC Press, 2001.
12 Toleikis JR: American Society of Neurophysiological Monitoring. Intraoperative monitoring
using somatosensory evoked potentials. A position statement by the American Society of To order, please contact your NuVasive Sales Consultant or Customer Service Representative today at:
®

Neurophysiological Monitoring. J Clin Monit Comput 2005 Jun; 19(3):241-58.
13 Banoczi W (2005) Update on Anesthetic and Metabolic Effects During Intraoperative
Neurophysiological Monitoring (IONM). Am J End Technol 45:225-39.
14 Sloan TB, Heyer EJ (2002) Anesthesia for intraoperative neurophysiologic monitoring of the
spinal cord. J Clin Neurophysiol 19(5):430-43.
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EMG
ELECTROMYOGRAPHY (EMG) MONITORING
NeuroVision® is being used for EMG monitoring during this
procedure. Muscle relaxants or paralytics should not be in
effect during the use of NeuroVision as they might interfere
with the electromyography readings.
For assistance, call: 877-963-8768 (toll-free)
TCeMEP
TRANSCRANIAL ELECTRICAL MOTOR EVOKED
POTENTIAL (TCeMEP) MONITORING
NeuroVision is being used for TCeMEP monitoring during this
procedure. In order to optimize the quality of monitoring, it is
recommended that anesthesiologist perform total intravenous
anesthesia (TIVA) and avoid neuromuscular blocking agents
post-induction. Failure to follow this recommendation may
result in suboptimal responses.
ANESTHESIA RECOMMENDATIONS FOR
TCeMEP MONITORING
• U
 se a bite-block and/or other means to protect from
potential bite injury 1
• Limit paralytics to induction dose only 2
• No volatile inhalation agents throughout procedure 3, 4, 5
• TIVA utilizing propofol and narcotic is optimal 6
(High infusion rates of propofol may cause diminution of MEPs)
• A
 dministration of IV agents (except for induction) should be
performed via a constant infusion and NOT bolus administration
to prevent transient depression in MEP amplitudes 7
• A
 lthough in many patients it may be possible to obtain MEP
responses with low levels of volatile inhalation agents and/
or nitrous oxide, multiple studies have shown the use of such
agents reduces or even eliminates reliable responses 8, 9, 10
(Particularly in patients with pre-existing neurological deficits)
Refer to NeuroVision Quick Reference Manual for additional information.
SSEP
ANESTHESIA RECOMMENDATIONS FOR
SOMATOSENSORY EVOKED POTENTIAL
(SSEP) RECORDING
• Muscle relaxants may be used as they do not affect
SSEP response11
• As they reduce amplitude and increase latency in a
dose-dependent fashion, volatile inhalation agents
should be kept at less than 0.5 MAC (minimum
alveolar concentration)12
• If used, nitrous oxide must be kept at less than 50%
as it reduces amplitude and increases latency in a
dose-dependent fashion greater than equipotent
concentrations of volatile inhalation agents12, 13
• Avoid combining nitrous oxide and volatile inhalation
agents as they produce more depression of signals
than when used individually12, 14
• Total intravenous anesthesia (TIVA) utilizing propofol
and narcotic is optimal12, 14
• Administration of IV agents (except for induction)
should be performed via a constant infusion and
NOT bolus administration to prevent transient
depression of responses14