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Hi SDN Anesthesia hive mind,
I had a very curious case and a cursory literature review didn't answer my question.
Have you ever had a patient where you were simply unable to get baseline MEPs, despite all your efforts? We had a patient come in for a procedure and after anesthesia, lines etc neuromonitoring could not get any LE signals (and small UE signals). We tried swapping all our needles, equipment, cables etc and nothing. He did get a whiff of roc for induction / lines but quant TOF was normal (both ours and via the neuromonitoring stim), and we gave him sugammadex anyway without any change.
We did a wake-up test and the patient had an excellent exam (he had no deficits pre-op and we hadn't really done anything to him yet), but even after re-sedating him we were unable to get anything.
Ultimately the surgeon decided that there needed to be a more in-depth convo with the patient if we were going to proceed without NM capability (high-risk surgery), so we elected to cancel and come back another day. I will say though I'm stumped as to what was happening. We truly swapped out everything so I can't imagine it's a technical issue (always possible, of course, but it certainly didn't seem that way) -- so it must be something related to the patient? Anyone experienced this or have any thoughts?
There are a few papers out there but they mostly talk about spine surgery patients who have baseline myelopathy / weakness, which was not the case here. Our neurologist who runs the NM group was stumped, too.
I had a very curious case and a cursory literature review didn't answer my question.
Have you ever had a patient where you were simply unable to get baseline MEPs, despite all your efforts? We had a patient come in for a procedure and after anesthesia, lines etc neuromonitoring could not get any LE signals (and small UE signals). We tried swapping all our needles, equipment, cables etc and nothing. He did get a whiff of roc for induction / lines but quant TOF was normal (both ours and via the neuromonitoring stim), and we gave him sugammadex anyway without any change.
We did a wake-up test and the patient had an excellent exam (he had no deficits pre-op and we hadn't really done anything to him yet), but even after re-sedating him we were unable to get anything.
Ultimately the surgeon decided that there needed to be a more in-depth convo with the patient if we were going to proceed without NM capability (high-risk surgery), so we elected to cancel and come back another day. I will say though I'm stumped as to what was happening. We truly swapped out everything so I can't imagine it's a technical issue (always possible, of course, but it certainly didn't seem that way) -- so it must be something related to the patient? Anyone experienced this or have any thoughts?
There are a few papers out there but they mostly talk about spine surgery patients who have baseline myelopathy / weakness, which was not the case here. Our neurologist who runs the NM group was stumped, too.
