Impact of anesthetic management on Intraoperative Neurophysiological Monitoring: Narrative review

Authors

DOI:

https://doi.org/10.31157/an.v27i2.313

Keywords:

Anesthesia, Neuroanesthesia, Intraoperative Neurophysiological Monitoring, Colunm surgery, Complications, Safety

Abstract

The spinal pathology of the main causes of chronic neurogenic pain and disability in the general population. Intraoperative neurophysiological monitoring (IOMM) allows monitoring and evaluating the integrity of the motor and sensory systems in procedures that put the nervous system (NS) at risk and avoid complications.

Objective: Review of peer-reviewed publications; Identify and describe the main OUNM techniques and the impact of anesthetic and perioperative management on them.

Methods: A systematic and narrative search and review was carried out in English and Spanish, using the MEDLINE, Scopus and PubMed databases, using the MeSH terms: "Intraoperative Neurophysiological Monitoring"; "Anesthesia"; "Neuroanesthesia"; "Perioperative Management"; "Spine surgery", "Complications", "Safety".

Results: Current national and international clinical guidelines for spine surgery recommend multimodal MIOI in spinal and intracranial surgery to evaluate the functional integrity of the NS.

Understanding influence of anesthetics and other variables on the recordings is critical to the success of the MNIO. As the technique of choice, total intravenous anesthesia (TIVA) with propofol is recommended for a better recording of PEM and PESS (LE: 2C).

Conclusions.

It is essential to understand the clinical bases of the different IOMM techniques and to interpret alerts and alarm criteria in a timely manner to obtain better surgical results and prevent permanent neurological injuries.

The neuroanesthesiologist must ensure an adequate state of anesthetic depth, hempodynamic stability and cerebromedullary perfusion pressure, avoiding modifications that alter the recordings.

KEY WORDS: Anesthesia; Neuroanesthesia; Intraoperative Neurophysiological Monitoring; Colunm surgery; Complications; Safety.

What do we know about this problem and what does this study contribute?

Despite the wide dissemination and recommendation of the use of Intraoperative Neurophysiological Monitoring (IONM) by international guidelines, there is little dissemination and understanding by anesthesiologists about the type of techniques, as well as the importance and impact of anesthetic and perioperative management on the same.

This study identifies and describes the main IONM techniques, as well as the impact of drugs, hemodynamic variables, anesthetic and perioperative management on IONM.

Author Biography

César Alejandro Martínez de los Santos, Instituto Nacional de Neurología y Neurocirugía

Tesis de Subespecialidad “Ensayo Clínico: Evaluación del sangrado perioperatorio en resección de meningiomas con el uso de ácido tranexámico comparado con placebo”.
· Tesis de Maestría “Ensayo clínico de Intubación Endotraqueal con y sin el uso de Bloqueador Neuromuscular en niños” Junio 2016.
· Asesor de Tesis de Especialidad: Comparación De Tres Pautas De Sedación Con Ketamina. Febrero 2019.
· Asesor de Tesina Hemorragia obstétrica y periparto: uterotónicos y Anestesia del XX Diplomado de Analgesia y Anestesia en Ginecología y Obstetricia de la SMAGO A.C. Octubre 2016.
· Martínez-de los Santos CA, et al. Análisis del comportamiento de infecciones nosocomiales y evaluación de dos esquemas de profilaxis pre-quirúrgica en un centro de referencia neurológica. Archivos de Neurociencias 2019:24(2);59-66.
· Monárez -Prieto D, Villacobos- Granados S, Martínez-de los Santos CA. Comparación De Tres Pautas De Sedación Con Ketamina. Rev Med Torreón 2019:11;6-11.
· Martínez-de los Santos CA, et al. Test de Wada, otras aplicaciones de los anestésicos intravenosos. Anestesia en Mexico 2019:31(1);119-121.
· Cruz-Cruz EF, Peralta-Sánchez C, Valdivia-Chiñas H, Martínez-de los Santos CA. Paciente con hemofilia tipo A: sometido a drenaje de hematoma intraparenquimatoso: Manejo anestésico. Anestesia en Mexico 2019: 32(2);88-90.
· Vaca Aguirre L, Martínez-de los Santos CA, Islas Álvarez M. Correcta colocación de catéter venoso central guiado por electrocardiografía. Anestesia en Mexico 2019:31(1);97-98.
· Martínez-de los Santos CA, Espinoza de los Monteros-Estrada I. Alternativas en el manejo de la hemorragia aguda en el transoperatorio. Rev Mex Anest 2016: 39(S1);S276-S280

Published

2022-06-13

How to Cite

Martínez de los Santos, C. A. (2022). Impact of anesthetic management on Intraoperative Neurophysiological Monitoring: Narrative review. Archivos De Neurociencias, 27(2), 19–30. https://doi.org/10.31157/an.v27i2.313

Issue

Section

Evidence synthesis