Intraoperative Neurophysiological Monitoring (IONM) - Revision history

Wdoyon: /* Anesthesia and IONM */

2019-11-12T02:41:15Z

Anesthesia and IONM

← Older revision		Revision as of 21:41, 11 November 2019
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	'''Muscle relaxants.''' Muscle relaxants are used clinically for 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 optimal for recording of baseline signals, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for 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 optimal for recording of baseline signals, which 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.

			Muscle relaxants have an inhibitory effect on compound muscle action potentials recorded for transcranial MEPs, cranial nerve MEPs, and pedicle screw stimulation.

	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.		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.

	==References==		==References==

Wdoyon: /* Anesthesia and IONM */

2019-11-12T02:13:50Z

Anesthesia and IONM

← Older revision		Revision as of 21:13, 11 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts by enhancing GABA-A neurotransmission via increased chloride conductance, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Other intravenous agents, like ketamine, may increase inhibitory transmission indirectly by blocking the excitatory effects of glutamate. Overall, propofol affects IONM recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses ~~involved in~~ the ~~neural pathway~~. Cortical SSEP and EEG recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs, brainstem auditory evoked responses (BAERs), and ~~motor~~ cranial nerve MEPs, with fewer synaptic connections between the stimulation and recording sites, are less affected. Gas anesthesia does have a strong inhibitory effect on transcranial MEPs recorded from muscle tissue. The effect of gas on MEPs occurs at the anterior horn where ~~the~~ upper motor neurons synapse with lower motor neurons. Although single-pulse MEPs are easily inhibited, the effect of gas can be ~~partially~~ overcome by using multi-pulse MEPs.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts by enhancing GABA-A neurotransmission via increased chloride conductance, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Other intravenous agents, like ketamine, may increase inhibitory transmission indirectly by blocking the excitatory effects of glutamate. Overall, propofol affects IONM recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses between the stimulation and recording site. Cortical SSEP and EEG recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs, brainstem auditory evoked responses (BAERs), and cranial nerve MEPs, with fewer synaptic connections between the stimulation and recording sites, are less affected. Gas anesthesia does have a strong inhibitory effect on transcranial MEPs recorded from muscle tissue. The effect of gas on MEPs occurs at the anterior horn where upper motor neurons synapse with lower motor neurons. Although single-pulse MEPs are easily inhibited, the effect of gas can be overcome to some degree by using multi-pulse MEPs.

	'''Muscle relaxants.''' Muscle relaxants are used clinically for ~~the~~ intubation ~~of patients~~ 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 optimal for baseline ~~recordings~~, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for 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 optimal for recording of baseline signals, which 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.		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.

	==References==		==References==

Wdoyon: /* Anesthesia and IONM */

2019-11-11T04:47:42Z

Anesthesia and IONM

← Older revision		Revision as of 23:47, 10 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts by enhancing GABA-A neurotransmission via increased chloride conductance, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Other intravenous agents, like ketamine, may increase inhibitory transmission indirectly by blocking the excitatory effects of glutamate. Overall, propofol affects IONM recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP and EEG recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected. Gas anesthesia ~~also has~~ a strong inhibitory effect on transcranial MEPs recorded from muscle tissue. The effect of gas on MEPs occurs at the anterior horn where the upper motor neurons synapse with lower motor neurons, ~~as well as at~~ the ~~neuromuscular junction~~.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts by enhancing GABA-A neurotransmission via increased chloride conductance, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Other intravenous agents, like ketamine, may increase inhibitory transmission indirectly by blocking the excitatory effects of glutamate. Overall, propofol affects IONM recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP and EEG recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs, brainstem auditory evoked responses (BAERs), and motor cranial nerve MEPs, with fewer synaptic connections between the stimulation and recording sites, are less affected. Gas anesthesia does have a strong inhibitory effect on transcranial MEPs recorded from muscle tissue. The effect of gas on MEPs occurs at the anterior horn where the upper motor neurons synapse with lower motor neurons. Although single-pulse MEPs are easily inhibited, the effect of gas can be partially overcome by using multi-pulse MEPs.

	'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.

Wdoyon: /* Anesthesia and IONM */

2019-11-11T04:40:38Z

Anesthesia and IONM

← Older revision		Revision as of 23:40, 10 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts ~~as a positive allosteric modulator of the~~ GABA-A ~~receptor~~, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Overall, propofol affects ~~ION~~ recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts by enhancing GABA-A neurotransmission via increased chloride conductance, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Other intravenous agents, like ketamine, may increase inhibitory transmission indirectly by blocking the excitatory effects of glutamate. Overall, propofol affects IONM recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP and EEG recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected. Gas anesthesia also has a strong inhibitory effect on transcranial MEPs recorded from muscle tissue. The effect of gas on MEPs occurs at the anterior horn where the upper motor neurons synapse with lower motor neurons, as well as at the neuromuscular junction.

	'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.

Wdoyon: /* Anesthesia and IONM */

2019-11-11T03:43:25Z

Anesthesia and IONM

← Older revision		Revision as of 22:43, 10 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. ~~Propofol~~ affects Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission ~~and~~ are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Overall, propofol affects ION recordings to a lesser degree than other anesthetics. Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission but are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected.

	'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.

Wdoyon: /* Anesthesia and IONM */

2019-11-11T02:51:13Z

Anesthesia and IONM

← Older revision		Revision as of 21:51, 10 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol ~~is a~~ general ~~anesthetic that~~ acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (~~gas~~) ~~anesthesia is~~ often contraindicated for IONM ~~because it inhibits synaptic transmission and other neural processes~~. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are ~~several~~ synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected~~. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic~~.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol, like other general anesthetics, acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Propofol affects Inhalation (gaseous) anesthetics, such as sevoflurane and desflurane, also act by enhancing inhibitory neurotransmission and are often contraindicated for IONM. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are multiple synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected.

	'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.

Wdoyon: /* Anesthesia and IONM */

2019-11-09T14:48:53Z

Anesthesia and IONM

← Older revision		Revision as of 09:48, 9 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these ~~measurements~~, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these signals, whereas subcortical SSEPs with fewer synaptic connections are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.

	'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.		'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.

Wdoyon: /* Anesthesia and IONM */

2019-11-08T10:12:26Z

Anesthesia and IONM

← Older revision		Revision as of 05:12, 8 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these measurements, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.		'''Types of anesthesia.''' Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these measurements, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.

			'''Muscle relaxants.''' Muscle relaxants are used clinically for the intubation of patients 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 optimal for baseline recordings, which 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.

	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.		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.

	==References==		==References==

Wdoyon: /* Anesthesia and IONM */

2019-11-08T10:08:11Z

Anesthesia and IONM

← Older revision		Revision as of 05:08, 8 November 2019
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	==Anesthesia and IONM==		==Anesthesia and IONM==
	Anesthetics can have a profound influence over IONM ~~signals~~. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these measurements, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.		Anesthetics can have a profound influence over IONM recordings. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these measurements, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.

Wdoyon: /* Anesthesia and IONM */

2019-11-08T10:02:22Z

Anesthesia and IONM

← Older revision		Revision as of 05:02, 8 November 2019
Line 14:		Line 14:

	==Anesthesia and IONM==		==Anesthesia and IONM==
	Anesthetics can have a profound influence over IONM. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these measurements, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.		Anesthetics can have a profound influence over IONM signals. TIVA (total intravenous anesthesia) is a cocktail of drugs that is given intravenously. One important component of TIVA is the drug propofol. Propofol is a general anesthetic that acts as a positive allosteric modulator of the GABA-A receptor, and it may also act directly as an agonist and affect other neurotransmitter systems as well. Inhalation (gas) anesthesia is often contraindicated for IONM because it inhibits synaptic transmission and other neural processes. The affect of gas anesthesia on electrophysiological recordings is proportional to the number of synapses involved in the neural pathway. Cortical SSEP recordings are particularly sensitive to gas because there are several synapses that contribute to these measurements, whereas subcortical SSEPs are less affected. Sevoflurane and desflurane are common gas anesthetics, which have replaced isoflurane as the preferred gas anesthetic.