Term
| When monitoring SSEPs for Posterior Tibial nerve it is important to watch for changes in: |
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Definition
| amplitude, latency of the waveform and changes from baseline |
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Term
| For the ABR which are important to monitor |
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Definition
| latency of Wave V, changes in I - V latency |
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Term
| The cortical recording sites for SSEPs are |
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Definition
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Term
| For surgery at C4 - C5 using SSEPs what is the primary stimulation site? |
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Definition
| median nerve or ulnar nerve |
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Term
| The motor tracts in the spinal cord can be monitored by: |
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Definition
| transcranial electrical stimulation, trancranial magnetic stimulation, neurogenic spinal cord stimulation |
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Term
SSEPs are elicited by stimulating either a sensory or mixed peripheral nerve
T/F |
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Definition
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Term
EMGs are an effective methods to monitor pedicle screw placement
T/F |
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Definition
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Term
| Which forms of monitoring are best for surgery at L5-S1 |
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Definition
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Term
| The types of electrodes used in monitoring: |
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Definition
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Term
For EMGs in IOM we are primarily interested in either the presence or absence of activity so we do not watch for amplitude
T/F |
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Definition
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Term
| What are technical problems with NMEPs |
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Definition
| cervical or high thoracic stimulation may produce an artifact on the EKG, shorting out may occur, irrigation fluids or blood may reduce stimulating current |
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Term
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Definition
| some muscle relaxants are good |
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Term
| tEMGs are generally used to |
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Definition
| identify specific nerves or nerve roots, verify placement of pedicle screws, identify neural tissue imbedded in a tumor |
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Term
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Definition
| Neurogenic MEP records activity from the nerves. The spinal cord motor tract is stimulated and the response is measured below the surgical site at the muscle or peripheral motor nerve |
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Term
| What is the difference between a monopolar and bipolar stimulation and when they would be used in a surgery |
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Definition
| Mono: one stim site is used, to monitor lower limb function; bi: 2 parallel sites are used, upper limb function. |
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Term
| How can you tell you have enough stimulation for SSEPs? |
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Definition
| get a cortical response, get a twitch and get a response at Erb's |
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Term
| For neurogenic MEPs possible stimulation sites are |
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Definition
| translaminar, percutaneous |
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Term
| For myogenic MEPs you want how many twitches? |
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Definition
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Term
| How would you determine you have enough stimulation for SSEP and MEPs |
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Definition
| You will see a twitch in the muscle or muscle group you are interested in |
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Term
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Definition
| maximum alveolar concentration |
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Term
| What 3 substances can have a negative effect on SSEPs? |
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Definition
| halothane, enflurane, desflourane |
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Term
Propofol must be given intravenously
T/F |
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Definition
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Term
| What can cause burst activity when monitoring the facial nerve? |
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Definition
| traction on the nerve, heating the nerve by the cautery, dissection or drilling near the nerve |
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Term
Preparation, attention to detail, documentation and communication are all critical to intraoperative monitoring
T/F |
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Definition
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Term
| When beginning to monitor in the OR, it is important to: |
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Definition
| find a mentor, get to know the OR staff, study the anatomy and physiology |
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Term
| Which muscles are typically used when monitoring the facial nerve? |
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Definition
| orbicularis oculi, orbicularis oris |
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Term
| Which monitoring techniques might be used for cranial surgeries? |
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Definition
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Term
Surgery for an acoustic neuroma might include ABR, spontaneous EMG and tEMG
T/F |
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Definition
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Term
| For VEPs the active electrodes are placed at: |
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Definition
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Term
The effects of anesthetics on intraoperative monitoring are dose dependant
T/F |
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Definition
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Term
| How can you tell if the anesthesia are causing changes in the response rather than the surgical procedure? |
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Definition
| Use of a control recording, above the site of the surgery. If both below and above are impacted, then is the anesthesia |
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Term
Intraoperative VEPs are highly reliable and useful in retro-orbital surgeries
T/F |
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Definition
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Term
| For EMGs you want how many twitches? |
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Definition
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Term
| what type of monitoring would be used for posterior fossa aneurysm surgery? |
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Definition
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Term
| When notifying the surgeon about a change, it is important to: |
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Definition
| speak with certainty, document that you notified the surgeon, make sure the surgeon responds verbally and document the exchange, find out how the surgeon would like to be notified before the surgery |
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Term
| Name four members of the OR team: |
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Definition
| surgeon, circulating nurse, scrub nurse, surgical. orthopedic tech, anesthesiologist |
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Term
| What is the most important in the OR? |
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Definition
| Having good communication with the surgical players |
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Term
| What are some causes of electrical interference: |
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Definition
| OR table, blood warmers, the bovie |
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Term
The ground electrode should be placed between the recording site and the stimulating electrodes
T/F |
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Definition
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Term
| There are ? cervical, ? thoracic, ? lumbar, ? fused sacral, ? fused coccygeal vertebrae for a total of 33 |
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Definition
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Term
| Name 4 physiologic variables that may affect the monitoring |
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Definition
| EEG activity/level of anesthesia, blood pressure, body temp, oxygenation, ventilation, for EMG - level of muscle relaxants |
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Term
The spinothalamic tract in the spinal cord is in the dorsal column and carries the sensory information
T/F |
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Definition
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Term
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Definition
| a chemical, excites or inhibits neural response |
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Term
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Definition
| continuous recording of muscle contractions |
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Term
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Definition
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Term
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Definition
| neutralization of the neurotransmitters |
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Term
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Definition
| sheathing around a peripheral nerve |
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Term
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Definition
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Term
| What are types of recording electrodes? |
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Definition
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Term
| What is a notch filter used for? |
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Definition
| removing 60 Hz interference |
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Term
Most use the international 10-20 system for electrode placement
T/F |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| What is and where would you find the cauda equina? |
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Definition
| A collection of nerve roots in the lower back below L1 |
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Term
| What nerves can be found in the brachial plexus? |
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Definition
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Term
| The spinal cord and spinal nerves are supplied by: |
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Definition
| anterior, posterior spinal arteries and anterior radicular arteries |
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Term
Low electrode impedance is more important than balanced electrode impedance to reduce noise and optimize recordings
T/F |
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Definition
| False (both are important) |
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Term
| Name problems for which spinal surgery would be performed and might use IOM: |
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Definition
| spinal tumor, disk pressing on spinal cord or nerves, bone pressing on the spinal cord, scoliosis surgery |
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Term
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Definition
| the natural resistance that allows substances to pass through a cell membrane into the brain |
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Term
Averaged evoked responses are typically recorded from the central nervous system and non-averaged responses are obtained from the peripheral structures
T/F |
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Definition
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