When should we warn the surgeon?

Clinical neurophysiologists use brainstem auditory evoked potentials (BAEPs) to monitor the auditory nerve during surgery in which there is a risk of postoperative hearing deficits. Over the last 25 years, monitoring these potentials has decreased operative morbidity by providing the operating team prompt feedback about the functional integrity of the auditory pathway.1–4 Despite this fact, there are no uniformly accepted criteria for determining when an observed BAEP waveform change demands the attention of the surgeon.5 Ethical considerations prevent studies specifically addressing what changes might indicate impending complications. Specific but divergent warning criteria have been proposed based …