By Aatif M. Husain
A functional method of Neurophysiologic Intraoperative Monitoring covers all elements of neurophysiologic intraoperative tracking (NIOM), that's more and more getting used to constantly check the sensible integrity of a sufferer s worried procedure in the course of surgical procedure. With education in NIOM seldom on hand in conventional courses, this booklet is the single functional resource for crucial info at the medical perform of NIOM.
The booklet is split into handy sections: part One, simple rules, covers the modalities utilized in tracking in addition to the not often mentioned themes of distant tracking, billing, moral matters, and a customer s advisor for establishing a laboratory. part experiences anatomy, body structure, and surgical procedure of many of the systems, by means of information of the tracking modalities and their interpretive standards.
Special gains include:
• Portability: effortless to hold and use
• contains all significant kinds of surgical procedures for which NIOM is requested
• info on paying for, education, set-up, and billing that isn't on hand at any place else
• a special technical part on the finish of every bankruptcy that studies the logistics of tracking a specific kind of surgery
• invaluable for trainees and skilled clinicians
With large use of bullet issues, tables, and illustrations, this handbook is key studying for neurologists, neuroanesthesiologists, neurosurgeons, and OR techs.
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Extra info for A Practical Approach to Neurophysiologic Intraoperative Monitoring
This is particularly true in cases where EEG activity is being recorded at 2 µV/mm to determine electrocerebral inactivity; at such a high sensitivity, artifacts are difficult eliminate. 4). 1 An electrocautery machine. 2 Example of artifact caused by electrocautery. This was seen when tibial somatosensory evoked potentials were being averaged. 3 A cardiopulmonary bypass machine. This machine can also be used to administer anesthetic agents and other drugs as well as for inducing hypothermia. 4 An operating surgical microscope.
It is important for the technologist to be present for this testing so that, if the patient does not respond as expected, the surgeon can question the technologist (and neurophysiologist) about the NIOM. In addition, if the surgeon finds it necessary to reoperate emergently, the NIOM team may be asked to monitor for the emergent procedure. DOCUMENTATION Thorough and complete documentation is of critical importance in NIOM. It serves not only to provide information about what happened during the casebut also to protect the NIOM team should postoperative complications occur (5).
Communication with the Surgeon Spinal instrumentation must be anchored to the vertebral column in order to provide support and allow bony fusion. Screws are often placed in the pedicle to provide this anchor; if they are malpositioned, however, EMG is considered by many to be the simplest form of NIOM. While this may be the case, the above discussion shows that one must still have a healthy respect for the com- Motor Nerve Conduction Studies (“Triggered EMG”) Electrical Evaluation of Pedicle Holes and Screws Husain 02 1/17/08 28 • 11:52 AM Page 28 SE C T I ON I : B a s i c P r i n c iple s they may impinge on exiting nerve roots, causing radiculopathy.
A Practical Approach to Neurophysiologic Intraoperative Monitoring by Aatif M. Husain