Rule out systemic causes before surgical maneuvers: 1. MAP < 80 mmHg 2. Anesthetic bolus (Propofol/Fentanyl) 3. Hypothermia or Anemia
Guidelines for iatrogenic injury prevention.
Pulse Signal Probe
Input significant electrophysiological waveform changes across MEP and SSEP modalities to determine if surgical safety thresholds have been breached.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Continuous neurophysiological tracking during deformity correction, spinal tumor resection, and complex cranial procedures.
Requires an awake, communicative neurophysiologist parsing data against baseline variables.
Section 2
Literature
Development
Rooted directly in literature from the Scoliosis Research Society (SRS). Initial paradigms focused strictly on Somatosensory Evoked Potentials (SSEPs). The addition of Motor Evoked Potentials (MEPs) dramatically increased sensitivity to anterior cord ischemia (the primary blood supply of motor tracts), where SSEPs (posterior columns) might remain entirely normal despite catastrophic motor damage.
Section 3
Pearls/Pitfalls
The Anesthetic Effect
MEPs are exquisitely sensitive to inhaled anesthetics (gases) and neuromuscular blockade. Any sudden alert must be immediately triangulated with the anesthesiologist to confirm no propofol bolus or gas adjustments occurred before assuming surgical traction caused the deficit.
Section 4
Evidence Appraisal
Primary Reference
Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey
Nuwer MR et al. • Electroencephalogr Clin Neurophysiol. 1995;96(1):6-11
