Intraoperative neurophysiology monitoring in scoliosis surgery in children
•Is Intraoperative neurophysiology monitoring (INM) needed in scoliosis surgery?•Our experience with INM in 61 surgeries in 56 children shows that it is useful.•Propose alert criteria for Transcranial electrical motor evoked potentials in INM.•We recommend the use of total intravenous anaesthesia fo...
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Published in | Clinical neurophysiology practice Vol. 4; pp. 11 - 17 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.01.2019
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Abstract | •Is Intraoperative neurophysiology monitoring (INM) needed in scoliosis surgery?•Our experience with INM in 61 surgeries in 56 children shows that it is useful.•Propose alert criteria for Transcranial electrical motor evoked potentials in INM.•We recommend the use of total intravenous anaesthesia for INM.
Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice.
We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries.
INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics.
INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets – amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM.
Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option. |
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AbstractList | OBJECTIVEIntraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. METHODSWe retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. RESULTSINM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. CONCLUSIONSINM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets - amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. SIGNIFICANCEOur study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option. Objective: Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. Methods: We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. Results: INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. Conclusions: INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets – amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. Significance: Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option. Keywords: Intraoperative neurophysiology monitoring, Scoliosis surgery, Children, Transcranial electrical stimulation evoked motor potentials, Somatosensory evoked potentials, Total intravenous anaesthesia Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets - amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option. •Is Intraoperative neurophysiology monitoring (INM) needed in scoliosis surgery?•Our experience with INM in 61 surgeries in 56 children shows that it is useful.•Propose alert criteria for Transcranial electrical motor evoked potentials in INM.•We recommend the use of total intravenous anaesthesia for INM. Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets – amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option. • Is Intraoperative neurophysiology monitoring (INM) needed in scoliosis surgery? • Our experience with INM in 61 surgeries in 56 children shows that it is useful. • Propose alert criteria for Transcranial electrical motor evoked potentials in INM. • We recommend the use of total intravenous anaesthesia for INM. |
Author | Woodland, Peter Dillon, David Ghosh, Soumya Palumbo, Linda Nagarajan, Lakshmi Thalayasingam, Priya Lethbridge, Martyn |
AuthorAffiliation | d Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA 6009, Australia e Dept of Orthopaedics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia a Children’s Neuroscience Service, Dept. of Neurology, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia f Dept. of Anaesthetics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia b School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia c Telethon Kids Institute, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia |
AuthorAffiliation_xml | – name: c Telethon Kids Institute, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – name: b School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia – name: d Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA 6009, Australia – name: a Children’s Neuroscience Service, Dept. of Neurology, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – name: f Dept. of Anaesthetics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – name: e Dept of Orthopaedics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia |
Author_xml | – sequence: 1 givenname: Lakshmi surname: Nagarajan fullname: Nagarajan, Lakshmi organization: Children’s Neuroscience Service, Dept. of Neurology, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – sequence: 2 givenname: Soumya surname: Ghosh fullname: Ghosh, Soumya email: soumya.ghosh@health.wa.gov.au organization: Children’s Neuroscience Service, Dept. of Neurology, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – sequence: 3 givenname: David surname: Dillon fullname: Dillon, David organization: Dept of Orthopaedics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – sequence: 4 givenname: Linda surname: Palumbo fullname: Palumbo, Linda organization: Children’s Neuroscience Service, Dept. of Neurology, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – sequence: 5 givenname: Peter surname: Woodland fullname: Woodland, Peter organization: Dept of Orthopaedics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – sequence: 6 givenname: Priya surname: Thalayasingam fullname: Thalayasingam, Priya organization: Dept. of Anaesthetics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia – sequence: 7 givenname: Martyn surname: Lethbridge fullname: Lethbridge, Martyn organization: Dept. of Anaesthetics, Perth Children’s Hospital, Hospital Avenue, Nedlands, WA 6009, Australia |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30828671$$D View this record in MEDLINE/PubMed |
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Keywords | Scoliosis surgery Transcranial electrical stimulation evoked motor potentials Children Somatosensory evoked potentials Total intravenous anaesthesia Intraoperative neurophysiology monitoring |
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Snippet | •Is Intraoperative neurophysiology monitoring (INM) needed in scoliosis surgery?•Our experience with INM in 61 surgeries in 56 children shows that it is... Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine... OBJECTIVEIntraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis... • Is Intraoperative neurophysiology monitoring (INM) needed in scoliosis surgery? • Our experience with INM in 61 surgeries in 56 children shows that it is... Objective: Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing... |
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SubjectTerms | Children Clinical and Intraoperative neurophysiology monitoring Scoliosis surgery Somatosensory evoked potentials Total intravenous anaesthesia Transcranial electrical stimulation evoked motor potentials |
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Title | Intraoperative neurophysiology monitoring in scoliosis surgery in children |
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