S16-2. Strategy in anesthetic management for intraoperative neuromonitoring

• Published in: Clinical neurophysiology 2018-05, Vol.129 (5), p.e30-e30
• Main Authors: Kawaguchi, Masahiko, Takatani, Tsunenori, Nakase, Hiroyuki
• Format: Article
• Language: English
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2018.02.064

The development of postoperative functional dysfunction can have an impact on the length of hospital stay, total medical costs, and necessity of dependency. To maintain functional integrity, neuromonitoring including motor evoked potential (MEP), sensory evoked potential, and visual evoked potential, has been conducted during the operation. Anesthetic management is usually based on the maintenance of MEP, which is most susceptible to suppression by anesthetic agents. MEP is indicated for craniotomy, spine surgery and aortic surgery, in which the technique for stimulation and recording can vary on types of surgery. Especially, stimulus intensity and technique should be carefully applied for craniotomy. Anesthetic management remains to be challenging during MEP monitoring in aortic surgery, in which cardiopulmonary bypass with aortic occlusion and hypothermia is conducted. In pediatric cases, the selection of anesthetic agents and monitoring of anesthetic depth remained to be debated. Anesthetic fade of MEP in prolonged surgery is possible topic to be overcomed. Although the use of remifentanil and sugamadex made anesthetic management for MEP easy, patient’s movement and bite injury in response to stimulation seem to be a problem, which needs to be resolved. Safety management of multidisciplinary monitoring team is also important issue for further progress.