Monitoreo con potenciales evocados/Evoked potentials monitoring

Consideraciones anestésicas en el monitoreo con potenciales evocados


Bithal PK. Anaesthetic considerations for evoked potentials monitoring.
J Neuroanaesthesiol Crit Care [serial online] 2014 [cited 2014 Feb 3];1:2-12.
Abstract
Intra-operative neurophysiologic monitoring (IONM) under anaesthesia has achieved popularity because it helps prevent/minimize neurologic morbidity from surgical manipulations of various neurologic structures. Neurologic functions in an anaesthetised patient can be monitored either by electroencephalography (EEG) or by evoked potentials. Whereas, EEG is difficult to analyse, evoked potentials, in contrast, are easy to interpret, they are either present or absent, delayed or not delayed, with normal or abnormal wave. The goal of IONM is to identify changes in nervous system function prior to irreversible damage. Many factors need consideration when selecting an anaesthetic regimen for intra-operative monitoring of evoked potentials. The very pathophysiological condition or the potential risks of the contemplated surgical procedure, which require evoked potentials monitoring, may place constraints on anaesthetic management as well. With the availability of numerous anaesthetic techniques, an appropriate plan for managing both anaesthesia and IONM in a patient should be organised. It is extremely essential not to alter the pharmacological state of the patient to avoid any changes in the recording of evoked responses. While an anaesthesiologist may alter plans for a patient in order to facilitate IONM, monitoring team too, sometimes may be required to modify plans for monitoring when a particular anaesthetic agent or technique is strongly indicated or contraindicated. At times, compromise may be required between an anaesthesia technique and a monitoring technique. To serve patients' best interest, it is critical to have a team approach and good communication among the neurophysiologist, anaesthesiologist and surgeon.
Keywords: Anaesthetics, neurophysiologic monitoring, non-anaesthetic factors
http://www.jnaccjournal.org/text.asp?2014/1/1/2/124832



http://www.jnaccjournal.org/downloadpdf.asp?issn=2348-0548;year=2014;volume=1;issue=1;spage=2;epage=12;aulast=Bithal;type=2



Monitoreo fisiológico intraoperatorio: principios básicos y actualización reciente

Intraoperative neurophysiologic monitoring: basic principles and recent update.
Kim SM, Kim SH, Seo DW, Lee KW.
J Korean Med Sci. 2013 Sep;28(9):1261-9. doi: 10.3346/jkms.2013.28.9.1261. Epub 2013 Aug 28.
Abstract
The recent developments of new devices and advances in anesthesiology have greatly improved the utility and accuracy of intraoperativeneurophysiological monitoring (IOM). Herein, we review the basic principles of the electrophysiological methods employed under IOM in the operating room. These include motor evoked potentials, somatosensory evoked potentials, electroencephalography, electromyography, brainstem auditoryevoked potentials, and visual evoked potentials. Most of these techniques have certain limitations and their utility is still being debated. In this review, we also discuss the optimal stimulation/recording method for each of these modalities during individual surgeries as well as the diverse criteria for alarm signs.
KEYWORDS:Evoked Potential, Guideline, Intraoperative Neurophysiologic Monitoring



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763097/pdf/jkms-28-1261.pdf

Revisión sobre monitoreo intraoperatorio para cirugía espinal
A review of intraoperative monitoring for spinal surgery.
Surg Neurol Int. 2012;3(Suppl 3):S174-87. doi: 10.4103/2152-7806.98579. Epub 2012 Jul 17.
Stecker MM.

Abstract
BACKGROUND: Intraoperative neurophysiologic monitoring (IONM) is a technique that is helpful for assessing the nervous system during spine surgery. METHODS: This is a review of the field describing the basic mechanisms behind the techniques of IONM. These include the most often utilized trancranial motor evoked potentials (Tc-MEPs), somatosensory evoked potentials (SSEPs), and stimulated and spontaneous EMG activity. It also describes some of the issues regarding practices and qualifications of practitioners. RESULTS: Although the anatomic pathways responsible for the Tc-MEP and SSEP are well known and these clinical techniques have a high sensitivity and specificity, there is little published data showing that monitoring actually leads to improved patient outcomes. It is evident that IONM has high utility when the risk of injury is high, but may be only marginally helpful when the risk of injury is very low. The monitoring team must be well trained, be able to provide the surgeon feedback in real time, and coordinate activities with those of the surgical and anesthesia teams. CONCLUSIONS: Although IONM is a valuable technique that provides sensitive and specific indications of neurologic injury, it does have limitations that must be understood. Maintaining a high quality of practice with appropriately trained personnel is critical.
KEYWORDS: Intraoperative neurophysiologic monitoring, motor evoked potentials, somatosensory evoked potentials, spine



http://www.surgicalneurologyint.com/downloadpdf.asp?issn=2152-7806;year=2012;volume=3;issue=4;spage=174;epage=187;aulast=Stecker;type=2




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org