Those Dang Neuromonitoring people

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lakersbaby

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Anyone else get super annoyed at these people. I understand the importance of neuromonitoring for some cases but the way they obsess over MY anesthetic is freakin annoying. They constantly try to tell me what to do with my Volatile and my infusions. They insist when I am on like 0.2 MAC that my gas is weakening their signals. I pretend to turn it off and they tell me they are magically much better.

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Ah, the neuromonitoring people. I think most of us spend the first couple neuro-heavy years of residency letting our blood boil every time they saunter up to the anesthesia machine in that passive-aggressive fashion. by CA-3 year and beyond you've perfected ways of ignoring it as long as you're doing your due diligence to optimize signals and it won't bother you one bit. They gotta bother someone when the signals suck, easier you then the surgeon!
 
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Its even more annoying when at the end of the case he comes over and asks what this is and do i still need it and the thing he is holding in his hand is the patients triple lumen.
 
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Its even more annoying when at the end of the case he comes over and asks what this is and do i still need it and the thing he is holding in his hand is the patients triple lumen.
Why would the neuro monitoring people ask that kind of question? Why would they care about anything after final signals other than when you're taking down the drapes so that they can take the needles out.
Oh, you mean it got pulled out during the flip. Lol.
 
Anyone else get super annoyed at these people. I understand the importance of neuromonitoring for some cases but the way they obsess over MY anesthetic is freakin annoying. They constantly try to tell me what to do with my Volatile and my infusions. They insist when I am on like 0.2 MAC that my gas is weakening their signals. I pretend to turn it off and they tell me they are magically much better.

HOLY CRAP YOU AND I MUST HAVE SOME KIND OF MIND-MELD GOING ON!!!

I just did a PLIF today with pedicle screws. And some apparently new IONM chick who I'll guess was between 28-30 years old and who the company must've just hired and whom I've never met before walks in the room and starts setting up her stuff while I'm getting my TIVA stuff set-up. She proceeds to say, "Hey, anesthesia. I need to run SSEPs, EMG, and MEPs. So just do propofol, remi, and you can run a half a MAC of sevo if you want. Just use sux when you intubate because I need to get baselines."

I literally -- no exaggeration -- started laughing out loud. I mean, I almost fell down I was laughing so hard. The circulator who's extremely cool and was in the room helping to do counts looks over at me and then at this chick and says, "His name is Dr. Phreed and it isn't his first day."

This poor girl turned a bright shade of purple. Didn't say another word during the whole case. :D
 
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Why would the neuro monitoring people ask that kind of question? Why would they care about anything after final signals other than when you're taking down the drapes so that they can take the needles out.
Oh, you mean it got pulled out during the flip. Lol.

I guess one could rip me for the quality of my suturing, but no the case was done and he pulled it along with some of his leads, brought it over and asked if i still needed it. ass.
 
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Our folks are annoying but we usually have great relationship. However, last month I had just finished putting in a subclavian CVC when our dude nearly put his bare hand on the insertion site when I turned to grab a tegederm to dress it. My attending yelled at him- "WTF are you thinking, you almost contaminated our lime!" Like the lady above, he didn't say much the entire case.

I usually do 0.6mg/kg/hr ketamine for the majority of the case, and some propofol. PO Tylenol in preop, 50mg/kg Mag bolus before incision and usually don't need more than 250mcg fent and 1-2mg dilaudid for most 1-5 level spines I've done. Sometimes I run a bit of gas 0.5-1 etSevo if they don't tolerate >90mcg/kg/min prop. Usually their signals are fine with up to 1/2 Mac of gas.
 
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I generally ask "what would you like me to do so I can ignore it?" Most of our techs are decent to work with. They ask politely before crowding our space to put in needles or take them out. We're now doing primarily propofol/ketamine/lidocaine infusions for our bigger spine cases with 1/2 MAC or less of gas and just a little narcotic. They seem to be happy with this. I don't hesitate to tell them and the surgeon if I think they're nuts with their monitoring requests.
 
What do these people actually do and what is their role? Never heard of this before
 
So much unnecessary drama.

Head it off. Approach them and say "I understand you'll be doing SSEPs and MEPs for this case, I'll be running _____ for the anesthetic." Say it in a way that shows you already know what they're doing and have taken it into account for your anesthetic plan. Because you do, and you have, right?

If they respond with anything resembling a contrary demand or expectation, you can be polite yet dismissive. And then just do the case.


Remember, these techs sometimes do cases with providers who DON'T know how to run an appropriate anesthetic. I can't really blame them if they feel the need to get bossy. I would too, if I had their job and was repeatedly confronted with providers who pushed roc on a case I was going to do MEPs for.

Be a doctor, take control, go to them first, inform them of your plan, and be done with it.
 
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HOLY CRAP YOU AND I MUST HAVE SOME KIND OF MIND-MELD GOING ON!!!

I just did a PLIF today with pedicle screws. And some apparently new IONM chick who I'll guess was between 28-30 years old and who the company must've just hired and whom I've never met before walks in the room and starts setting up her stuff while I'm getting my TIVA stuff set-up. She proceeds to say, "Hey, anesthesia. I need to run SSEPs, EMG, and MEPs. So just do propofol, remi, and you can run a half a MAC of sevo if you want. Just use sux when you intubate because I need to get baselines."

I literally -- no exaggeration -- started laughing out loud. I mean, I almost fell down I was laughing so hard. The circulator who's extremely cool and was in the room helping to do counts looks over at me and then at this chick and says, "His name is Dr. Phreed and it isn't his first day."

This poor girl turned a bright shade of purple. Didn't say another word during the whole case. :D
Was she good looking?
 
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Yes they are annoying, but as pgg said, initiate the dialogue and demonstrate your appreciation for their monitoring. I'll usually inquire from time to time if they got a good baseline or if their signals are good. This usually keeps them placated. It does irk me though when they complain that nitrous is contraindicated.
 
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I'll do whatever the neuromonitoring people want, as long as it's not unsafe for the patient.

They're there for the patient and surgeon. We are there for the patient and surgeon. We should have a solid relationship with them.
 
Was she good looking?

Unfortunately, no. Not remotely. Maybe if she lost 100 lbs and hadn't hit every branch in the ugly tree she fell out of. Also if I were to venture a guess (and I don't think I would be far off base) I believe it is also highly likely that she isn't into men.

As far as the other observations here on this thread that have been offered about IONM folks, here's mine: they are outsiders.

Let me explain.

These are people who have quite simply not had to endure the "hierarchical" training we have had to endure that has gotten us to this point. So, their OR etiquette usually sucks. It's not that they're not important to what's going on. It's that they (sometimes) falsely believe that they are the only important thing going on in the OR. What I mean by that is that they believe their input into the case is paramount, and every other concern is secondary to theirs. Again, it's because they have not really "trained" to understand that there are about 1,000 other things equally -- if not in most cases more -- important going on.

So, for example, they can be kind of clueless in the sense that, for one of them who is attractive and with whom I've worked with a lot over the years, I was immediately "Buzz" the first day she was in the OR with me, and not "Dr. Phreed". She was, how can I put this, very "casual" about everything going on and immediately very comfortable about calling me by my first name. There are people I've worked with for 7 1/2 years there -- who I've asked to call me by first name -- who still call me Dr. Phreed. When we first started working together for these cases she would routinely get in the way when I was in the middle of starting the case. You know, stuff like just walking into the space between me and the patient without asking first. She frequently barked out orders about how she needed this, or needed that. Again, it wasn't the impoliteness that has been gently corrected over the years. She was still pleasant enough. That was never the issue. It was just routine gross deviation from the standard "decorum" expected in the OR.

Now, it's just funny to me. It's funny because I believe that this new "tech" (and that's what they are) was probably "trained" by this other person with whom I've worked and now have a great rapport. In her case it simply would've been nicer, for example, if she'd asked me what I was going to do for the anesthetic, if I had any concerns, etc., etc. instead of assuming that I didn't know anything. And if she had simply said she what she was planning on monitoring instead of telling me how to give the patient anesthesia. I may have had concerns beyond her comprehension with regards to this patient, and frankly it's not her worry or issue to address.

It's funny because they sort of tell you what you should do without having any clue what what they are saying actually means for the patient and not just what they need to get on their equipment. I was tempted to tell her that the patient told me that there is a questionable family history of malignant hyperthermia and then ask her if it would still be okay if I gave the succinylcholine. But I didn't. Her behavior was just so funny to me. I think she wast trying to show me what she (thought she) knew, but it just came out so... I dunno... stupid. Remifentanil? We don't even have remi on formulary in our hospital. She didn't introduce herself. She didn't approach me. It was just, "Hey anesthesia!" and then a litany of demands. You guys get the picture. Not even a basic understanding of proper OR etiquette. At least she had a bouffant and mask on.

Too funny. If I'd been younger and less experienced I may have chewed her head off. Now I can just laugh about it.
 
Unfortunately, no. Not remotely. Maybe if she lost 100 lbs and hadn't hit every branch in the ugly tree she fell out of. Also if I were to venture a guess (and I don't think I would be far off base) I believe it is also highly likely that she isn't into men.

As far as the other observations here on this thread that have been offered about IONM folks, here's mine: they are outsiders.

Let me explain.

These are people who have quite simply not had to endure the "hierarchical" training we have had to endure that has gotten us to this point. So, their OR etiquette usually sucks. It's not that they're not important to what's going on. It's that they (sometimes) falsely believe that they are the only important thing going on in the OR. What I mean by that is that they believe their input into the case is paramount, and every other concern is secondary to theirs. Again, it's because they have not really "trained" to understand that there are about 1,000 other things equally -- if not in most cases more -- important going on.

So, for example, they can be kind of clueless in the sense that, for one of them who is attractive and with whom I've worked with a lot over the years, I was immediately "Buzz" the first day she was in the OR with me, and not "Dr. Phreed". She was, how can I put this, very "casual" about everything going on and immediately very comfortable about calling me by my first name. There are people I've worked with for 7 1/2 years there -- who I've asked to call me by first name -- who still call me Dr. Phreed. When we first started working together for these cases she would routinely get in the way when I was in the middle of starting the case. You know, stuff like just walking into the space between me and the patient without asking first. She frequently barked out orders about how she needed this, or needed that. Again, it wasn't the impoliteness that has been gently corrected over the years. She was still pleasant enough. That was never the issue. It was just routine gross deviation from the standard "decorum" expected in the OR.

Now, it's just funny to me. It's funny because I believe that this new "tech" (and that's what they are) was probably "trained" by this other person with whom I've worked and now have a great rapport. In her case it simply would've been nicer, for example, if she'd asked me what I was going to do for the anesthetic, if I had any concerns, etc., etc. instead of assuming that I didn't know anything. And if she had simply said she what she was planning on monitoring instead of telling me how to give the patient anesthesia. I may have had concerns beyond her comprehension with regards to this patient, and frankly it's not her worry or issue to address.

It's funny because they sort of tell you what you should do without having any clue what what they are saying actually means for the patient and not just what they need to get on their equipment. I was tempted to tell her that the patient told me that there is a questionable family history of malignant hyperthermia and then ask her if it would still be okay if I gave the succinylcholine. But I didn't. Her behavior was just so funny to me. I think she wast trying to show me what she (thought she) knew, but it just came out so... I dunno... stupid. Remifentanil? We don't even have remi on formulary in our hospital. She didn't introduce herself. She didn't approach me. It was just, "Hey anesthesia!" and then a litany of demands. You guys get the picture. Not even a basic understanding of proper OR etiquette. At least she had a bouffant and mask on.

Too funny. If I'd been younger and less experienced I may have chewed her head off. Now I can just laugh about it.


Neuromonitor here.

& no, I'm not a tech.

Your view of neuromonitoring reflects who you may be as a physician. My anesthesia coworkers and I have a good relationship because I respect them and they respect me. Clearly, your ego is so big you haven't matured enough to realize why you're in an OR. To do your job and help the patient, focus on that.

I have a ph.d in neuroscience from an ivy league institution, I know how to handle myself in an OR because I care about what I do, and I'm appreciative of those who don't assume before learning of who I am and what I do.

Yes, there are most likely people who suck at the job and don't know how to talk to people or handle themselves in an OR, but there are also ***** anesthesiologists who make comments that just make them look like completely vapid individuals with no actual life experience.
 
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Neuromonitor here.

& no, I'm not a tech.

Your view of neuromonitoring reflects who you may be as a physician. My anesthesia coworkers and I have a good relationship because I respect them and they respect me. Clearly, your ego is so big you haven't matured enough to realize why you're in an OR. To do your job and help the patient, focus on that.

I have a ph.d in neuroscience from an ivy league institution, I know how to handle myself in an OR because I care about what I do, and I'm appreciative of those who don't assume before learning of who I am and what I do.

Yes, there are most likely people who suck at the job and don't know how to talk to people or handle themselves in an OR, but there are also ***** anesthesiologists who make comments that just make them look like completely vapid individuals with no actual life experience.
Hi tech
 
Neuromonitor here.

& no, I'm not a tech.

Your view of neuromonitoring reflects who you may be as a physician. My anesthesia coworkers and I have a good relationship because I respect them and they respect me. Clearly, your ego is so big you haven't matured enough to realize why you're in an OR. To do your job and help the patient, focus on that.

I have a ph.d in neuroscience from an ivy league institution, I know how to handle myself in an OR because I care about what I do, and I'm appreciative of those who don't assume before learning of who I am and what I do.

Yes, there are most likely people who suck at the job and don't know how to talk to people or handle themselves in an OR, but there are also ***** anesthesiologists who make comments that just make them look like completely vapid individuals with no actual life experience.

Rofl
 
Neuromonitor here.

& no, I'm not a tech.

Your view of neuromonitoring reflects who you may be as a physician. My anesthesia coworkers and I have a good relationship because I respect them and they respect me. Clearly, your ego is so big you haven't matured enough to realize why you're in an OR. To do your job and help the patient, focus on that.

I have a ph.d in neuroscience from an ivy league institution, I know how to handle myself in an OR because I care about what I do, and I'm appreciative of those who don't assume before learning of who I am and what I do.

Yes, there are most likely people who suck at the job and don't know how to talk to people or handle themselves in an OR, but there are also ***** anesthesiologists who make comments that just make them look like completely vapid individuals with no actual life experience.
You resurrect a two year old dead thread for THIS as your first post? OMG - ROFLMAO

My coworkers are the people in my department - physicians and anesthetists. They are not the surgeons, or the techs of any flavor or the nurses in the OR, even though I like and respect all of them and we all have a great working relationship. No offense intended, but in our shop, PhD or not (and we could care less about Ivy league anything from anyone), you would be considered a tech, because you're offering technical advice and reporting observations that you see, but aren't physically taking responsibility for the care of the patient like the surgeon and anesthesia team, nor do you have any professional liability to the patient that comes close to approaching ours. In our place, the neuro TECH hooks up the patient to their devices and reports what they see on their screen - but they're also online constantly with a neurologist (who IS actually on the hook from a liability standpoint) sitting watching a screen (or several screens) at some remote location - and the neuro TECH relays any pertinent communication from the neurologist to the surgeon.

Lighten up Francis.
 
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Neuromonitor here.

& no, I'm not a tech.

Your view of neuromonitoring reflects who you may be as a physician. My anesthesia coworkers and I have a good relationship because I respect them and they respect me. Clearly, your ego is so big you haven't matured enough to realize why you're in an OR. To do your job and help the patient, focus on that.

I have a ph.d in neuroscience from an ivy league institution, I know how to handle myself in an OR because I care about what I do, and I'm appreciative of those who don't assume before learning of who I am and what I do.

Yes, there are most likely people who suck at the job and don't know how to talk to people or handle themselves in an OR, but there are also ***** anesthesiologists who make comments that just make them look like completely vapid individuals with no actual life experience.

Welcome to the forum.

I'm sure your next post will be the kind of well-informed, interesting bit of clinical (or even non-clinical!) discussion that we like to see from non-anesthesiologist professionals. We like visitors.
 
Yes, there are most likely people who suck at the job and don't know how to talk to people or handle themselves in an OR, but there are also ***** anesthesiologists who make comments that just make them look like completely vapid individuals with no actual life experience.

That is undoubtedly the case, but the post you were quoting was not an example of such an individual. Everything he said was perfectly reasonable, and the fact that you don't understand that proves that you still don't understand or respect what anesthesiologists do, nor do you understand the bigger picture of how ORs work.

Overall, I've worked with a few good, but a few more bad monitoring techs (I've occasionally seen neurologists come into the room for consultation, but they don't stay, and I honestly don't know what your role as a PhD would be in such a case). I would say that most of them know absolutely nothing about the patient, could care less about actual patient care, and are only interested in the quality of their signals so that they can make the surgeon happy.

So maybe you should focus less on telling other people what their role is in patient care, and more on understanding what yours is.
 
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We run all of our SSEP/MEP cases under TIVA - just easier that way and it provides a nice, stable anesthetic. We are trained to do so from CA-1 so it's cumbersome at first, but once you get the hang how to set everything up it's not bad.

Our neuroanesthesiologists actually assume coverage and staff the neuromonitoring in our institution which is a huge plus and helps with some of the concerns others have brought forward.
 
Good to see people NOT using remi as much for spines these days :)
 
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I just hope my neuromonitoring techs are at least observant enough to notice when they are responding to a 2 year old thread and trying to argue with someone who hasn't even posted in at least a year.

We run all of our SSEP/MEP cases under TIVA - just easier that way and it provides a nice, stable anesthetic. We are trained to do so from CA-1 so it's cumbersome at first, but once you get the hang how to set everything up it's not bad.

First off - no it's not easier to do it that way, and it's a little sad that's what you are being taught to do. Does TIVA give great signals - sure, and there are times when you have to go that route. But doing every case that way is silly. That's the equivalent of being taught to do an AFOI for every pt who's a Mallampati 2. It's also a cookie cutter nurse way to think, "SSEP/MEP = TIVA, must not deviate from protocol" (say it in your best robot voice).

SSEP's are pretty resilient, and even MEP's stay strong in the setting of sub-MAC doses of volatile provided the pt is neuro intact to begin with and baselines are strong, and the case isn't gonna take 6 hours. Toss in some low dose K and the signals are even better. TIVA is really only necessary for those cases where the pt has significant deficits to begin with and baselines are crappy as a result.
 
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