Intraoperative Neurophysiological Monitoring (IONM)
Introduction
Know your patient and the surgery
What at risk and need monitoring
Critical time during different surgeries
Choose monitoring techniques
Make plan for monitoring
Work as a member of the surgical team
Anesthesia and IONM
Muscle relaxants are needed for the intubation and surgical incisions. Common muscle relaxants include Rocuronium (ROC) and Succinylcholine (SUC). ROC is a steroid‐based non‐depolarizing muscle relaxant. ROC is a nicotinic receptor antagonist that has a duration of ~37-72 min with a standard dose. For intubation, a lower starting dose (~20 mg/kg) is better for IONM baseline measurements that typically happen shortly after intubation. SUC a nicotinic receptor agonist and a depolarizing neuromuscular blocker with a rapid onset and elimination. SUC causes desensitization because it is not hydrolyzed by acetylcholinesterase, which inhibits neurotransmission. Its duration of action is 6-10 min. In some cases SUC can cause hyperkalemia, variable increases in intracranial pressure, and intra‐ocular pressure. It is not recommended for denervation syndromes, muscular dystrophy, or malignant hyperthermia. When using ROC, care must be taken with people who have myasthenia gravis or myasthenic syndrome, hepatic disease, neuromuscular disease, carcinomatosis, or severe cachexia, as the duration of action may be significantly increased. – Tran et al. (2017) cited Annals of Pharmacotherapy 2014; 48: 62– 76.