Week 12 IOM from Presentation

Question 1

what are 3 other names for interoperative monitoring (IONM)

Answer 1

• neuro monitoring
• surgical neurophysiologist
• evoked potential technologist

Question 2

three neuro surgeries common to monitor for

Answer 2

• posterior lateral fusions
• anterior cervical fusions
• posterior cervical fusions

Question 3

one general surgery which requires monitoring

Answer 3

carotid endartarectomy (cleaning out the carotid artery)

Question 4

three ENT surgeries that require IONM

Answer 4

• acoustic neuromas
• thyroidectomy
• parotidectomy

Question 5

nems system

Answer 5

surgeon places electrodes and the machiene will just beep at the surgeon if they are getting too close

Question 6

SSEPs

Answer 6

• somatosensory evoked potentials
• measuring sensory function at the cortex; stimulate upper (fromthe wrist) or the lower (from the ankle)
• recorded variously throughout the procedure, looking for a decrease in amplitude (>50%) or an increase in latency (>10%) to the baseline taken before surgery

Question 7

TcMEPs

Answer 7

• transcranial motor evoked potentials
• opposite of SSEP
• motoring motor function through stimulating at the cortex and recording from any muscle in the extremities (usually the hand, leg, an foot)
• recording only when surgeon acknowledges because the patient will jerk
• does not require averaging, so only one stimulation is adequate

Question 8

EMG

Answer 8

• looking at nerve response by measuring the muscle activity of the muscle the nerve is serving
• gives info about nerve dysfunction
• runs throughout procedure and is expected to be quiet unless the nerve is purposely stimulated or if iatrogenic damage has occurred
• –facial nerve monitoring
• –cranial nerve monitoring
• –lower spinal surgeries

Question 9

four common types of IONM

Answer 9

• SSEPS
• TcMEPS
• EMG
• ABR

Question 10

main electrodes used in the OR

Answer 10

needle electrodes

• about 1 in
• placed in the scalp for recording electrodes for SSEPs
• placed in muscles of the face to monitor facial nerve
• for ABR place where you would stick sticky gel electrodes

Question 11

vagus nerve electrode

Answer 11

a sticker placed on the intubation tube placed into pts esophagus

• sticker sits between vocal folds and measures EMG
• –this would be used for a thyroidectomy

Question 12

what types of electrodes do we use as stimulating

Answer 12

only sticky electrodes

• want to use needle for TcMEPs and these are placed at the scale
• otherwise, use sticky electrodes as stimulating because needle electrodes can cause burns (SSEPs)
• –note that you dont stimulate for TcMEPs near as often as SSEPS

Question 13

what is the workflow of IONM

Answer 13

• gather equipment (cadwell)
• prep paperwork
• talk with anesthesia
• see pt and tell them who you are and what you do
• anesthesia brings pt in
• anesthesia does its thing
• prep the pt with electrodes
• check electrodes impedance
• –can also run baselines at this point so you have a point of comparison
• nurse preps patient/incision
• –this is when draping begins and after this you can’t touch anything because it is not the sterile field
• surgeon’s grand entry
• “time out”
• –pts name, procedure, allergies etc is relayed
• incision