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IOM basics 2

Interoperative monitoring basics 2

QuestionAnswer
In addition to mechanical irritation, two other potential sources for intense intra-op EMG activity temperature, osmotic irritation
The degree of nerve / nerve root irritation correlates with MUP __ __ firing rate
Asynchronous high rate trains of MUP are referred to as the __ __ interference pattern
The shape of MUPs are largely determined by these factors distance and orientation of MUPs
Monophasic MUPs are most likely __ (proximal/distal) to the recording electrode distal
Removal of epineurium, perineurium and +/- myelin leads to __ (increased/decreased) axonal depolarization in response to irritants increased
Once an axonal is disrupted, it will cease to produce an MUP in responses to __ (proximal/distal) irritation proximal
Sharp transection of an axon is usually associated with (high/low/no) amounts of EMG activity no (may have initial burst followed by silence)
Nerve ischemia / compression results in __ (increased/decreased/variable) EMG activity variable
Lumbar pedicle testing uses __ (bipolar/monopolar) stimulation monopolar
Lumbar pedicle testing uses __ (anodal/cathodal) stimulation cathodal
If the hole for a pedicle screw is tested and has a value of < 5 mA, perforation is __ probable
If the hole for a pedicle screw is tested and has a value of 5-7 mA, perforation is __ possible
If the hole for a lumbar pedicle screw is tested and has a value of > 7 mA, perforation is __ unlikely
If the hole for a pedicle screw is tested and has a value of < __ mA, performation is probable 5
If the hole for a pedicle screw is tested and has a value of > __ mA, perforation is unlikely 7
If the current required to activate adjacent nerves for a pedicle screw is tested and has a value of < 7 mA, perforation is __ probable
If the current required to activate adjacent nerves for a pedicle screw is tested and has a value of > 10 mA, perforation is __ unlikely
If the current required to activate adjacent nerves for a pedicle screw is tested and has a value of 7-10 mA, perforation is __ possible
If the current required to activate adjacent nerves for a pedicle screw is tested and has a value of __ mA, perforation is probable < 7
If the current required to activate adjacent nerves for a pedicle screw is tested and has a value of ___ mA, perforation is unlikely > 10
When stimulating the "hole" for a lumbar pedicle surgery, you stimulate using a balled tipped electrode as the __ (cathode/anode) cathode
In IOM with SEPs, global cortical loss with intact cortical signal suggests this Anesthetic effect
In IOMs with SEPs, unilateral cortical loss with intact subcortical signals suggests this Cerebral ischemia (for carotid surgery)
In IOMs, with SEPs, unilateral loss of Erb's point, subcortical and cortical signals suggests this Limb malpositioning
In IOM with SEPs, loss of subcortical and cortical signals with Erb's point intact suggests this Spinal cord dysfunction
The generator for N9 Brachial plexus
The generator for N11 Spinal nerve root
The generator for N13a Dorsal horn interneurons
The generator for N13b Dorsal column
The generator for P13 Spinomedullary junction
The generator for P14 Lemniscal pathway, cuneate nucleus
The generator for N18 Brainstem / thalamus
The generator for N19 Primary sensory cortex
The generator for P22 Primary motor cortex
Common chnnel used for N9 Epi-Epc
Common channel used for N11 Crv-Fpz
Common channel used for N13a Crv6-Fpz
Common channel used for N13b Crv2-Fpz
Common channel used for P13 Crv-Fpz, Mast-Fpz
Common channel used for P14 Crv-Fpz, Mast-Fpz
Common channel used for N18 Ci-noncephalic
Common channel used for N19 Cc-Fz, Cc-Ci
Common channel used for P22 Cc-Fz, Cc-Ci
Generator for N23 Dorsal horn interneurons
Typical channel for N23 T12-illiac crest
Typical channel for P31 Crv-Fpz, Mast-Fpz
Generator for P31 Medulla
Generator for N34 Primary sensory cortex
Channel for N34 Cc-Fpz
Generator for P38 Primary sensory cortex
Common channels for P38 Ci-Fpz, Cz-Fpz, Ci-Cc, Cz-Cc
Generator for N38 Primary sensory cortex
Common channel for N38 Cc-Fpz
For most IOM, at least __ muscles are used below the level of the surgery and __ above the level of thet surgery two, one
___ responses are averaged MEP signals that may be obtained from the spinal cord white matter tracts using an electrode in the subdural or epidural space D-waves
Transcranial activation of subcortical tracts with MEPs is elicited best with __ (anode/cathode) stimulation anode
For most intraoperative MEP setups, the __ (anode/cathode) is placed over the area of brain to be stimulated (C1 or C2) and the __ (anode/cathode) is placed contralaterally anode, cathode
MEPs are usually given in trains of __ - __ stimuli with an interstimulus interval of __ - __ msec 4-9, 2-4
For intraoperative monitoring, many individuals say that a signal is abnormal if there is a complete loss of signal or an abrupt __% decrease in amplitude 80
Gradual decreases in intraoperative MEP amplitude usually reflect metabolic changes or __ anesthesia
The contraindications to the use of MEPs in intraoperative monitoring brain DBS, cochlear implants, plegia, recent craniotomy / skull fracture
Agents with high MEP inhibiting potential volatile anesthetics, nitrous oxide
Agents with moderate MEP inhibiting potential benzodiazepines, propofol
Agents with little or no MEP inhibiting potential ketamine, etomidate, narcotics
White noise is introduced in the contralateral nonstimulated ear at ~ this level 60 dB nHl
Wave __ in the BAEP is negative I
A __ (rarefaction/condensation) click produces enhancement of wave I rarefaction
A loss of wave V amplitude of > __ is considered significant 50%
A __ msec prolongation in wave V latency is considered significant 0.5
Abrupt loss of wave I during surgery most likely reflects this compromise of the internal auditory artery
Created by: schmittse
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