A Concise Guide to Intraoperative Monitoring PDF
3.34 MB PDF
Intraoperative electrophysiological recordings are gradually becoming part of standard medical practice, mainly because they offer an objective and effective way to assess the functional integrity of the nervous system of patients during the course of orthopedic, neurological, or vascular surgery. Continuous monitoring of bioelectrical activity not only can avert damage of neurological structures that are at risk during certain surgical maneuvers, but also allows identification of specific neuronal structures and landmarks that cannot be easily recognized on anatomical grounds only.
Early applications of intraoperative monitoring were limited to a neuroprotective role. Today, however, monitoring not only decreases the risk for permanent neurological deficits but also provides surgeons with continuous information pertaining to the functional integrity of neuronal structures at risk and allows them to modify their actions accordingly in an effort to achieve optimal results.
Intraoperative monitoring is still not perfect. In fact, results are affected by several factors that may lead to false positive and negative judgments or interpretations. However, until more advanced procedures become available and practical, monitoring will remain a very useful and clinically valid procedure that can improve surgical outcome.
This book, based on our experience with the intraoperative monitoring service at Hermann Hospital and on that of others, introduces the various recording techniques available today, the rationale for their intraoperative use, the basic principles on which they are based, as well as problems typically encountered with their implementation. Specific features of the recorded signals, proper parameter settings for acquisition, and factors that affect the recordings, with emphasis on anesthetic agents and various neuroprotective induced conditions, such as hypothermia and hypotension, are reviewed in detail. Recommendations for procedure implementation, proper interpretation of the recordings, and successful equipment troubleshooting are also given. Finally, each chapter concludes with a series of questions to help the reader review the major points presented in the chapter.
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