SSEP Monitoring

jwk · Feb 8, 2006

First off, I would like your opinion of SSEP monitoring tech's and the limitations that they place on anesthesia providers, essentially tying hands.
Background:
Our SSEP techs usually state "1/2 mac iso, no paralytic other than induction dose of your choice, and no N20" for most prone cases of the back. Anterior cervical cases are usually a bit different, but can't remember off the top of my head.
Before I go into a long spill about the BS of their practice and how they can't tell shiznit about what level of gas I'm running without waking up from their nap and looking at my ET reading, I just want to get a feel for what you guys think about the monitoring.
You guys aren't exactly witholding in the opinion category, so let'em fly....

I usually start by asking "What do you want me NOT to give so I can ignore you?" :chuckle

Most of our techs now will ask, rather than tell us, what would work better for their readings. Depending on if it's SSEP's or EMG's or whatever, sometimes it doesn't make that much difference. If we think they're being unreasonable, we'll tell them. We'll also tell the surgeon that we can pretty much guarantee that their patient will either move or have awareness or both, and that generally settles things as well.

athomas91 · Feb 8, 2006

the ones i have worked w/ thus far have told us NO gas whatsoever - so we run propofol/remi infusions... and then i use them to titrate my drip - they really seem to hate it when i keep saying - "ok - how deep are they now..." i just giggle :)

gotosleep · Feb 8, 2006

I don't understand why they insist that you do not use muscle relaxants. That doesn't make sense to me. It's SSEP not MEP............

jwk · Feb 8, 2006

the ones i have worked w/ thus far have told us NO gas whatsoever - so we run propofol/remi infusions... and then i use them to titrate my drip - they really seem to hate it when i keep saying - "ok - how deep are they now..." i just giggle :)

This brings up a common issue - there is NO agreement that if you use X type of monitoring that you can't use Drug A or Gas B. Different services, different techs, different opinions, different "requirements". Makes no sense to me.

athomas91 · Feb 8, 2006

i agree... if it so affects results - the requirements should be standard, right?!?

on the muscle relaxant issue - they are stimulating the muscle/nerve and gauging the sensory response..is that right!!?

therefore muscle relaxant would affect the response to stimulation...

i could be wrong but i often see them twitching w/ the stim.;.

gotosleep · Feb 8, 2006

i agree... if it so affects results - the requirements should be standard, right?!?
on the muscle relaxant issue - they are stimulating the muscle/nerve and gauging the sensory response..is that right!!?
therefore muscle relaxant would affect the response to stimulation...
i could be wrong but i often see them twitching w/ the stim.;.[/quote
Muscle relaxants do not affect SSEP's; in fact, SSEP recordings can be more easily obtained with muscle relaxants, which suppress EMG activity. However, when EMG or myogenic MEP are to be recorded, muscle relaxants are contraindicated.

London88 · Feb 8, 2006

I was at a site where we would run close to1% forane and did not have a problem with muscle relaxants unless we were doing MEPs. Even with the MEPs the technician would inform us that it was okay to use vec or whatever muscle relaxant you choose as the MEP monitoring usually does not start until more than an our hour into the case, especially when surgery is on the anterior and posterior spinal column.

athomas91 · Feb 8, 2006

gotosleep -

thanks for the info...

gaspassah · Feb 9, 2006

i use it to hone skills in TIVA. i like tiva and try to find excuses to use it.

techs i work with suggest no paralytics if doing motor tests.

ssep's usually 1/2 mac agent and can paralyze.

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