Neuromonitoring

[GasPundit]

Just curious what the neuromonitoring guidelines are at the institution you work at. A covered cranium, or just BIS? SSEP? qEEG? Spectral analysis? Entropy monitors? TCD? NIRS?

When are you using them? CEA, CPB runs? I'm guessing relevant spine procedures get SSEP, but is anybody doing the transcranial magnetic stimulations?

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[rn29306]

Technicians usually request certain drugs and agent levels and we humor them as best we can.

Intubations are usually with vecuronium, then no paralytic after that. If they whine too much, we use mivacron.

Posterior backs usually get N20, half mac iso, and up-front loading of fentanyl. Have never had a tech state a problem with monitoring waveforms at this dose and have never had a patient wake up or have recall with these parameters.

Monitoring techs usually ask for TIVA with anterior approach cervical decompressions, usually diprivan and fentanyl at our facility. No problems with this approach either. On a side note, had an IV failure midway through one of these cases, so this pt had no anesthetic until a new IV could be established. Cracked the sevo canister up to an ET of 2.0 until new IV started and told the tech afterwards, he stated he never saw a change in the waveforms. Go figure.

 

[GasPundit]

Monitoring techs usually ask for TIVA with anterior approach cervical decompressions, usually diprivan and fentanyl at our facility. No problems with this approach either. On a side note, had an IV failure midway through one of these cases, so this pt had no anesthetic until a new IV could be established. Cracked the sevo canister up to an ET of 2.0 until new IV started and told the tech afterwards, he stated he never saw a change in the waveforms. Go figure.

Not really sure why propofol should be much different from sevo. These all sound like SSEP protocols. Any global cortical monitoring systems you use?

 

[rn29306]

Not really sure why propofol should be much different from sevo. These all sound like SSEP protocols. Any global cortical monitoring systems you use?

Other than the standard SSEP monitoring the techs use, then no. We are a teaching hospital and whatever is cheap is used (hence iso all the time). I don't know that any global cortical monitoring is implemented.

Hope this helps.