Neurologic Insult Intraop  

Posted bythespinebookadminPosted inComplications
  • SSEP 
    • Continuous (bottom up) 
    • Not sensitive to  
      • Perfusion 
      • Halothanes 
    • 50% amplitude, 10% latency 
    • Looks at dorsal columns, so it is inaccurate; most insults are anterior cord 
  • MEP 
    • Evoked (so delayed vs insult) (up to down) 
    • Sensitive to  
      • Perfusion 
      • Halothane 
    • 50% amplitude, 10% latency 
  • EMG 
    • Evoked 8 is no breach 

Management 

  • Notify 
    • Intraop pause 
    • Anesthesia 
    • NM 
    • Call for fluoro 
  • Rule out technical cause  
    • Electrodes 
    • Figure out pattern via signal changes 
  • Rule out anesthetic cause 
    • Halothanes 
    • NM blockade 
  • Rule out systemic cause  
    • MAP >70 
    • Temperature 
    • Wake up test 
  • Rule out surgical causses 
    • Remove traction 
    • Remove correction (ods) 
    • Remove screws 
    • Remove compressive (graft/ cage) 
    • (you hit the neural elements) 
  • Wake up test 
    • Flood field with NS, cover with sponges 
    • Reduce anesthesia until patient awake 
    • Don’t touch patient 
    • Loud clear voice to move 
  • If still not clear, close and CT