I just started my nuero rotation and would appreciate info to clarify the techniqes of anesthesia used when doing SSEP, MEP and EMG monitoring. I have heard 2 twitches, no NMB, 1 MAC, < 0.5 MAC, etc., etc. Also any other thoughts/tidbits on neuro rotation would be most appreciated!!!!
May 12, '07
I've got about 6 months of clinical left, so I'm certainly no expert. But, I usually ask the monitoring tech what is the most relaxation they can deal with, and keep in communication with them during the case to make sure that their monitoring is adequate. Some want just TIVA, so I use propofol and remi, or maybe some precedex. At other times, muscle relaxation down to 2 twithces is fine with them, so you can get away with less agent. I like neuro. Just keep up with where you are in the case (stimulation d/t entry into the cranium, dura, etc), watch the positioning (exp. for the long cases), and find out if your surgeon has any preferences. I hope this helps.
May 15, '07
if doing motor evoked potentials mep's you shouldnt use nmba, the tech is supposed to monitor for the quality of the twitch, not just is there one, it's kinda like measuring tof ratio for us.
sseps, some say you can use nmbas some say you cant, usually 1/2 mac with agent and propofol gtt, or straight tiva. we do tiva at my intitution. prop and remi