[susanna]

Question to all the anesthesia providers:
Do any of you work with END technicians in the OR, you know, the people who MEPs and SSEPs and other neurophysiological monitering on the patient with electrodes while the surgeon is working?

I wanted to know how used and how useful this field of work is. If so, do most ORs have these technicians? How helpful are they in protecting the patient from nerve damage? Did you get trained in school to do this type of monitering? Will anesthesia one day take over their job since they are monitering some of the same things anesthesia monitors?

[loisane]

We study evoked potentials in anesthesia school. I have never actually worked with them.

They were never used in any of the clinical facilities in which I have studied or worked. Even though these places did the types of cases that this type of monitoring is associated with. There was not a strong feeling about their usefullness, from either the surgical or anesthesia team.

Of course, I know there are lots of places that do use them. Hopefully someone with that experience will respond. My experience illustrates (I think), that they are not universal standards of care.

loisane crna

[susanna]

My hypothesis(and its just a hypothesis) is maybe this technique is for extra precaution only and that only very old/just new surgeons or surgeons who are sloppier(I'm not criticizing their surgical mortality, just noting that some surgeons are sloppier compared to their neater, more careful colleages) need to use this so that they don't damage anything serious. Anyone care to comment?

[stevierae]

Originally Posted by susanna

Question to all the anesthesia providers:
Do any of you work with END technicians in the OR, you know, the people who MEPs and SSEPs and other neurophysiological monitering on the patient with electrodes while the surgeon is working?

I wanted to know how used and how useful this field of work is. If so, do most ORs have these technicians? How helpful are they in protecting the patient from nerve damage? Did you get trained in school to do this type of monitering? Will anesthesia one day take over their job since they are monitering some of the same things anesthesia monitors?

As a legal nurse consultant and operating room nurse who has done many a spinal instrumentation case, I was involved as an expert in a complicated cervical spinal instrumentation case in which SSEP monitoring was planned to be used, and at the last minute was not used.

Patient wound up quadriplegic.

At that facility, known for its complicated spinal instrumentation cases, at that time, it was SOC; not using it was determined to be negligent.

I suspect--indeed, I hope-- that SSEP monitoring will become universal SOC for complicated C and T spine cases, particularly those involving instrumentation. Why not do everything humanly possible in the way of patient safety? Could it hurt?

SSEPs are not that helpful in L-spine instrumentation cases--but MEPs can be tremendously helpful.

FYI, there are neurologists and neuroanesthesiologists who oversee and even do MEP and SSEP monitoring; however, the monitoring is usually done by techs from the neurophysiology lab. I think it is going to be a pretty lucrative career choice in the near future for young people.

[susanna]

[quote=stevierae]
Patient wound up quadriplegic.

At that facility, known for its complicated spinal instrumentation cases, at that time, it was SOC; not using it was determined to be negligent.

I suspect--indeed, I hope-- that SSEP monitoring will become universal SOC for complicated C and T spine cases, particularly those involving instrumentation. Why not do everything humanly possible in the way of patient safety? Could it hurt?

SSEPs are not that helpful in L-spine instrumentation cases--but MEPs can be tremendously helpful.
END QUOTE]


I have so many questions.

If I can ask, after they removed the instrumentation, was the patient all right?

And is this monitering only used mainly for spinal surgery?

[stevierae]

[quote=susanna]

Originally Posted by stevierae

Patient wound up quadriplegic.

At that facility, known for its complicated spinal instrumentation cases, at that time, it was SOC; not using it was determined to be negligent.

I suspect--indeed, I hope-- that SSEP monitoring will become universal SOC for complicated C and T spine cases, particularly those involving instrumentation. Why not do everything humanly possible in the way of patient safety? Could it hurt?

SSEPs are not that helpful in L-spine instrumentation cases--but MEPs can be tremendously helpful.
END QUOTE]


I have so many questions.

If I can ask, after they removed the instrumentation, was the patient all right?

And is this monitering only used mainly for spinal surgery?

Susan, pm me and I will share more about this particular case with you.

SSEP monitoring is also used--not routinely, but depending on facility, availability, and how the surgeon trained-- during carotid endarterectomies (although vascular surgeons do not usually use it, neurosurgeons who do carotids sometimes do) and during craniotomies, especially those for aneurysms, tumors, AVMs, etc.

[Tenesma]

it is used often for carotids, c and t-spine work....most of the time we use SSEPs, but if there is concern for anterior cord involvement we add MEPs.... I oversee the SSEP tech in the OR and interpret changes (even though the older techs really don't need me for the most part). We also do SSEPs in the ICU to eval prognosis for pts w/ severe DAI.

[suzanne4]

Most of the techs work for an outside company and are contracted to the facility for that particular case.

Good luck!

[chicoborja]

check out AMERICAN SOCIETY OF
NEUROPHYSIOLOGICAL MONITORING
at www.asnm.org