Safety issues during surgical monitoring

Publisher Summary This chapter explores that intraoperative monitoring (IOM) normally improves patient safety, but like any medical procedure can inadvertently lead to harm. It addresses the nature and avoidance of hazards to patients and hospital staff in terms of electrical safety, procedure-specific safety, infection control, and essential performance. The chapter reviews that adhering to the principles of electrical safety, procedure-specific safety including the reservation of invasive methods for justified indications and infection control provides protection. Modern concepts of basic safety extend to essential performance that applies to IOM devices and practice. The chapter concludes that every reasonable effort should be made to reduce the likelihood of a failure in the essential performance of IOM. Expert care and interpretation emphasizing rapid selective methods with technical and systemic control can help accomplish this.

[1]  R. Lesser,et al.  Brief bursts of pulse stimulation terminate afterdischarges caused by cortical stimulation , 1999, Neurology.

[2]  N. P. Thomas,et al.  A system for the electrophysiological monitoring of the spinal cord during operations for scoliosis. , 1983, The Journal of bone and joint surgery. British volume.

[3]  J. Vermylen,et al.  Anticoagulants and spinal-epidural anesthesia. , 1994 .

[4]  R. Lesser,et al.  Anterior spinal cord injury with preserved neurogenic ‘motor’ evoked potentials , 2001, Clinical Neurophysiology.

[5]  D. McCreery,et al.  Considerations for Safety with Chronically Implanted Nerve Electrodes , 1990, Epilepsia.

[6]  Vedran Deletis,et al.  Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? , 2002, Child's Nervous System.

[7]  R. Fisher,et al.  Parameters for direct cortical electrical stimulation in the human: histopathologic confirmation. , 1990, Electroencephalography and clinical neurophysiology.

[8]  D. Burke,et al.  Corticospinal volleys and compound muscle action potentials produced by repetitive transcranial stimulation during spinal surgery , 2002, Clinical Neurophysiology.

[9]  A. Szelényi,et al.  Motor Evoked Potential Monitoring during Cerebral Aneurysm Surgery: Technical Aspects and Comparison of Transcranial and Direct Cortical Stimulation , 2005, Neurosurgery.

[10]  A. Al‐Shekhlee,et al.  Iatrogenic complications and risks of nerve conduction studies and needle electromyography , 2003, Muscle & nerve.

[11]  B. Stigsby,et al.  Tibial somatosensory evoked potential intraoperative monitoring: Recommendations based on signal to noise ratio analysis of popliteal fossa, optimized P37, standard P37, and P31 potentials , 2005, Clinical Neurophysiology.

[12]  A. Curt,et al.  Transcranial electrical stimulation: significance of fast versus slow charge delivery for intra-operative monitoring , 2002, Clinical Neurophysiology.

[13]  Jürgen Peters,et al.  Incidence of Neurologic Complications Related to Thoracic Epidural Catheterization , 1997 .

[14]  R. Keith,et al.  A Third-Degree Burn Caused By a Neurogenic Motor-Evoked Potential Monitoring Electrode During Spinal Surgery: A Case Report , 2003, Spine.

[15]  Michael Gaetz,et al.  Intraoperative Electrode Burns , 2003, Journal of Clinical Monitoring and Computing.

[16]  D. Macdonald.  Safety of Intraoperative Transcranial Electrical Stimulation Motor Evoked Potential Monitoring , 2002, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[17]  B. Stigsby,et al.  A comparison between derivation optimization and Cz′–FPz for posterior tibial P37 somatosensory evoked potential intraoperative monitoring , 2004, Clinical Neurophysiology.

[18]  M. Kofler,et al.  Brain stem mapping: neurophysiological localization of motor nuclei on the floor of the fourth ventricle. , 1995, Neurosurgery.

[19]  D.B. McCreery,et al.  Charge density and charge per phase as cofactors in neural injury induced by electrical stimulation , 1990, IEEE Transactions on Biomedical Engineering.

[20]  F. Shellock,et al.  MR procedures: biologic effects, safety, and patient care. , 2004, Radiology.

[21]  H. Morris,et al.  Hair loss after prolonged EEG/video monitoring , 1992, Neurology.

[22]  Herta Flor,et al.  Simultaneous electroencephalography and functional magnetic resonance imaging of primary and secondary somatosensory cortex in humans after electrical stimulation , 2002, Neuroscience Letters.

[23]  V. Deletis,et al.  Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results , 2006, Clinical Neurophysiology.

[24]  D. Vodušek,et al.  Transient paraplegia revealed by intraoperative neurophysiological monitoring: was it caused by the epidural anesthetic or an epidural hematoma? , 2003, Anesthesia and analgesia.

[25]  K. Omote,et al.  Acute respiratory and metabolic acidosis induced by excessive muscle contraction during spinal evoked stimulation. , 2001, British journal of anaesthesia.

[26]  B. Toth,et al.  Fire in the operating room: principles and prevention. , 2005, Plastic and reconstructive surgery.

[27]  Y. Katayama,et al.  Intraoperative monitoring of the corticospinal motor evoked potential (D-wave): clinical index for postoperative motor function and functional recovery. , 2004, Neurologia medico-chirurgica.

[28]  B. Stigsby,et al.  Monitoring Scoliosis Surgery With Combined Multiple Pulse Transcranial Electric Motor and Cortical Somatosensory-Evoked Potentials From the Lower and Upper Extremities , 2003, Spine.

[29]  W Harris,et al.  "Threshold-level" multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. , 1998, Journal of neurosurgery.

[30]  M. Fujiki,et al.  Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves. , 2006, Journal of neurosurgery.

[31]  E. Behnke,et al.  Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. , 2005, Journal of neurosurgery.

[32]  V. Amassian,et al.  Neurophysiological mechanisms underlying motor evoked potentials in anesthetized humans. Part 1. Recovery time of corticospinal tract direct waves elicited by pairs of transcranial electrical stimuli , 2001, Clinical Neurophysiology.

[33]  Daniel R. Merrill,et al.  Electrical stimulation of excitable tissue: design of efficacious and safe protocols , 2005, Journal of Neuroscience Methods.

[34]  Vedran Deletis,et al.  Intraoperative neurophysiology and methodologies used to monitor the functional integrity of the motor system , 2020, Neurophysiology in Neurosurgery.

[35]  N. Saito,et al.  Transcranial electrical stimulation through screw electrodes for intraoperative monitoring of motor evoked potentials. Technical note. , 2004, Journal of neurosurgery.

[36]  W. Seeling,et al.  Spinal hematoma: a literature survey with meta-analysis of 613 patients , 2002, Neurosurgical Review.

[37]  Henry Nider,et al.  Report of the Committee on Infectious Diseases , 1989 .

[38]  H. Journee,et al.  Influence of electrode impedance on threshold voltage for transcranial electrical stimulation in motor evoked potential monitoring , 2004, Medical and Biological Engineering and Computing.

[39]  I. S. Cooper.  Cerebellar stimulation in man , 1978 .

[40]  D. McCreery,et al.  Relationship between stimulus amplitude, stimulus frequency and neural damage during electrical stimulation of sciatic nerve of cat , 1995, Medical and Biological Engineering and Computing.

[41]  David B. MacDonald,et al.  Intraoperative Motor Evoked Potential Monitoring: Overview and Update , 2006, Journal of Clinical Monitoring and Computing.

[42]  R A Malkin,et al.  Cardiovascular collapse caused by electrocardiographically silent 60-Hz intracardiac leakage current. Implications for electrical safety. , 1999, Circulation.

[43]  M Seeck,et al.  EEG-Linked functional magnetic resonance imaging in epilepsy and cognitive neurophysiology. , 2000, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[44]  M. Janusz,et al.  An Approach to Intraoperative Neurophysiologic Monitoring of Thoracoabdominal Aneurysm Surgery , 2002, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[45]  D B McCreery,et al.  Considerations for safety in the use of extracranial stimulation for motor evoked potentials. , 1987, Neurosurgery.

[46]  J. Romaní,et al.  Calcinosis Cutis Following Calcium Chloride Electrode Paste Application for Auditory‐Brainstem Evoked Potentials Recording , 1998, Pediatric dermatology.

[47]  Christopher Nimsky,et al.  Anesthesia During High‐field Intraoperative Magnetic Resonance Imaging Experience with 80 Consecutive Cases , 2003, Journal of neurosurgical anesthesiology.

[48]  A. Szelényi,et al.  Motor evoked potentials. , 2019, Journal of neurosurgery.

[49]  A Goossens,et al.  Contact dermatitis from electrocardiograph‐monitoring electrodes: role of p‐tert‐butylphenol‐formaldehyde resin , 2003, Contact dermatitis.

[50]  C. Kalkman,et al.  Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. , 1999, Annals of surgery.

[51]  V. Deletis.  The ‘motor’ inaccuracy in neurogenic motor evoked potentials , 2001, Clinical Neurophysiology.