Intraop care plans and monitoring (MEPs, SSEPs) for spinal surgery patients

[stevierae]

I posted this on the OR nurse board, but would like to get feedback from anesthesia providers, too.

I know there, in theory, should be strict standardized care plans--both nursing and anesthetic-- in place for a lot of these patients--and I KNOW there should be for especially the C-spine patients who have potentially difficult airways--but I don't see some things done routinely (i.e, across the board) such as awake fiberoptic intubation, pt. left intubated at least overnight, admission to ICU (neuro ICU if available--)

What do you do at YOUR facility?

I am trying to get a feel for what the trend is in different parts of the country for a standardized intaraoperative care plan for spinal surgery.

To my colleagues who do spinal surgery (I know there are a lot of you:: Zoe, spineCNOR, Shodobe, kmchugh...)

Do you routinely monitor MEPs (motor evoked potentials) and/or SSEPs (somatosensory evoked potentials) during spinal surgery?

How LONG have you been doing it?

Do you do it during ALL spinal surgeries, or just the ones using instrumentation (i.e, TSRH, Moss Miami, Synthes...)

Do you do it just on C-spines, or on L and T spines as well?

Who brings, hooks up and watches the monitoring equipment? Is it an outside vendor, or do you have something in house like a neurophysiology lab?

Does anyone know if AORN has specific guidelines on the intraoperative care of the patient undergoing spinal surgery, and have your ORs developed care plans along those guidelines?

Do most ORs usually use intraoperative navigation systems such as the Stealth, or do you rely on pre-op X-rays, CTs and MRIs?

When you do get intraop films during spinal cases, especially during instrumentation cases, do you usually use fluoro, or do you get occasional cross-table laterals?

When you DO do intaop monitoring of MEPs and SSEPs, do you still do a "wake-up" test at some point during the surgery, and ask the patient to wiggle his toes?

Does your protocol vary depending on whether the operating surgeon is an orthopod or a neurosurgeon?

Thanks. I am very interested in hearing from any and all who do spine surgery. Please feel free to offer any bits of wisdom or tips that make your job easier.

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