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Intraoperative neurophysiological monitoring in neuroanesthesia

Nunes, Rogean R.a; Bersot, Carlos D.A.b; Garritano, João G.b

Current Opinion in Anesthesiology: October 2018 - Volume 31 - Issue 5 - p 532–538
doi: 10.1097/ACO.0000000000000645
NEUROANESTHESIA: Edited by Federico Bilotta

Purpose of review The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM).

Recent findings Over the last decades, neuromonitoring has advanced considerably, allowing for insights into neurological function during anesthesia and making it possible to assess intraoperative consciousness and neural integrity in real time. IONM is indicated in surgeries posing risk to targeted neural tissues and adjacent structures. The technique helps correlate surgical maneuvers with neurophysiological changes at high levels of sensitivity and specificity and can identify risk situations early enough to prevent postoperative neurological deficits.

Summary Experience with IONM, the use of an adequate IONM modality, and knowledge of the effect of anesthetic techniques and agents on neurophysiological parameters are fundamental for reliable measurements. The current gold standard in IONM is total intravenous anesthesia without neuromuscular block.

aDepartment of Anesthesiology, Hospital Geral de Fortaleza, Ceará

bDepartment of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil

Correspondence to Rogean R. Nunes, MD, PhD, Rua Comendador Francisco d’Angelo 1185, De Lourdes, Fortaleza, Ceará, Brazil, CEP: 60.177-130. E-mail:

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