General Anesthesia for Monitoring

Sloan, Tod B.

doi:10.1007/978-1-4614-0308-1_15

Cited by 7 publications

(1 citation statement)

References 52 publications

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“…In lumbar surgery, neuromonitoring is primarily needed at the lumbosacral levels. Limiting the stimulus to an area just proximal to the nerves of interest can reduce the unnecessary effects that may occur with concomitant upper extremity and cranial nerve stimulation [ 11 - 12 ]. Here, we presented TaMAPs in two porcine models.…”

Section: Discussionmentioning

confidence: 99%

Novel Transabdominal Motor Action Potential (TaMAP) Neuromonitoring System for Spinal Surgery

Hoshide¹,

Feldman²,

Gabel³

et al. 2016

Cureus

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IntroductionMinimally invasive lateral lumbar interbody fusion (LLIF) approaches to the lumbar spine reduce patient morbidity compared to anterior or posterior alternatives. This approach, however, decreases direct anatomical visualization, creating the need for highly sensitive and specific neurophysiological monitoring. We seek to determine feasibility in 'transabdominal motor action potential (TaMAP)' monitoring as an assessment for the integrity of the neural elements during lateral-approach surgeries to the lumbar spine. MethodsCathode and anode leads were placed on the posterior and anterior surfaces of two porcine subjects. Currents of varying degrees were transmitted across, from front to back. Motor responses were monitored and recorded by needle electrodes in specific distal muscle groups of the lower extremity. Lastly, the cathode and anode were placed anterior and posterior to the chest wall and stimulated to the maximum of 1500 mA to determine any effect on cardiac rhythm.ResultsResponses were seen by measuring vertical height differences between peaks of corresponding evoked potentials. Recruitment began at 200 mA in the lower extremities. Stimulation at 450 mA recruited a reliable and distinguishable electrographic response from most muscle groups. Responses were recorded and reliably measured and increased in proportion to the graduation of transabdominal stimulation current; no responses were seen in the arms or face. 1500 mA across the chest wall failed to stimulate or induce cardiac arrhythmia on repeated stimulation, indicating safety of stimulation.ConclusionTaMAPs seen in the animal model provide a potential alternative to standard transcranial motor evoked potentials done in the lateral approach of LLIFs. TaMAP recordings in most muscle groups were recordable and reliable, though some muscle groups failed to stimulate. Safety of transabdominal motor evoked potentials was confirmed in this porcine study. Future studies should examine TaMAPs reliability in detecting compressive lesions of nerve roots and peripheral nerves.

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Section: Discussionmentioning

confidence: 99%