Sensitivity, specificity, and surgical impact of somatosensory evoked potentials in descending aorta surgery

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…This technique has demonstrated increased sensitivity in predicting SCI compared with SSEP. 33,34 Major disadvantages of MEP are the influence of anaesthetic agents on the potential amplitude and the resistance of axonal conduction to ischaemia, which makes the response of MEP to ischaemia generally slow. 33 Institutional experience and availability of these techniques should determine their use.…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

“…In general, the comparatively low current incidence of neurologic complications is attributable to the routine use of multimodal neurophysiologic monitoring such as somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) in conjunction with neuroprotective strategies noted later (526). Although these neuroprotective strategies continue to evolve and may differ slightly in their implementation from center to center, monitoring of evoked potentials during these cases has become common because it provides the surgeon and anesthesiologist the opportunity to promptly intervene if alterations in monitored potentials indicate neurologic compromise is occurring (524,526,719,725,726). SSEPs are cerbral cortical electrical potentials recorded with scalp electrodes during electrical stimulation of the posterior tibial or peroneal nerves of the lower extremities, conducted via the lateral and posterior columns of the spinal cord (727).…”

Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in thoracic aneurysm repair

“…Commonly used measures to attempt to detect intraoperative ischemic events and predict adverse neurologic outcome include intraoperative neurophysiologic monitoring of the spinal cord and brain with somatosensory-evoked potentials (SSEPs) (Galla et al 1999;Guerit et al 1999;de Haan and Kalkman 2001;van Dongen et al 2001;Shine et al 2008), motor-evoked potentials (MEPs) (de Haan and Kalkman 2001; Jacobs et al 2006;Kakinohana et al 2007;Kawanishi et al 2007;Shine et al 2008), electrical cortical activity (EEG) (Wada et al 2001;Stecker et al 2001;McGarvey et al 2007;Rijsdijk et al 2009), and the measurement of presumptive biomarkers of ischemia (described below). SSEP measurement, routinely used during TAAA surgery, is widely considered to be safe and potentially beneficial and can be continued until patients have recovered from anesthesia (de Haan and Kalkman 2001; Winnerkvist et al 2007).…”

“…If significant changes in SSEPs, MEPs or EEGs occur, surgical and anesthetic interventions are initiated to attempt to improve spinal cord or brain perfusion. Any improvement in early detection of injury to the sensory or cortical pathway can alert the interpreting neurophysiologist and anesthesiologist of potential reversible injury, who in turn can provide guidance to the surgeon (Galla et al 1999;Guerit et al 1999;de Haan and Kalkman 2001;Wada et al 2001;van Dongen et al 2001;Cheung et al 2002).…”