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About Intraoperative Monitoring

In the past, patient’s were monitored during their surgeries primarily with a blood pressure cuff, electrocardiogram (ECG) and a stethoscope. Since the 1960’s an array of techniques have arisen to allow the anesthesiologist (the person that puts you to sleep) to more carefully monitor your condition while you are under anesthesia. These include tools to measure your blood oxygen, and carbon dioxide content, temperature and, in selected cases, pressures within the arteries, and lungs. This has coincided with a dramatic improvement in the rate of anesthesia related death, at least in part due to the better monitoring
Since 1986, the American Society of Anesthesiologists (ASA) has adopted standards for the use of these the new monitoring tools.

The Challenge

While standard intraoperative monitoring gives your surgeon and anesthesiologist a good picture of the status of your heart and lungs during your surgery, it is more difficult for them to tell if there is anything going wrong with your nervous system. For surgeries which place these organs at risk such as those to decompress the spinal cord or remove abnormal brain tissue, specialized monitoring is often useful to help avoid or minimize injury during surgery. These tools are now available to your surgeon in the form of neurophysiologic monitoring.

Neurophysiologic Monitoring

Neurophysiologic monitoring is an assortment of monitoring tools or techniques which may be used by your surgeon in different combinations to obtain a picture of the function of your nervous system at various points during your surgery. They usually record brain waves produced in response to several types of stimuli including small electrical pulses applied to peripheral nerves, flashes of light to the eyes and clicks of sound to the ears. Muscles are also monitored for abnormal electrical activity that might suggest injury to the nerve supplying them.
There are no lasting side effects from this stimulation. It does, however, allow your surgeon to assess the integrity of the part of the nervous system that he or she is working on or near to. This in turn allows for a quick response to evidence of injury or dysfunction,
More complex surgeries to insert stimulation devices in the brain monitor local brain cell activity to guide placement of the stimulator wire.
 

Richard A. O'Brien MD

Information and Support Groups for some disorders that may require neurophysiological monitoring:

• World Arnold-Chiari Association
• The Brain Trust (brain tumors and other disorders)
• Brain Injury Association of America
• National Brachial Plexus Association
• Scoliosis Research Society
• North American Spine Society
• American Academy of Orthopaedic Surgeons