WHAT IS INTRAOPERATIVE NEUROMONITORING?
By Nicole Mongelli
A globally growing subspecialty in the neurology space, intraoperative neuromonitoring, or IONM, assesses the functional integrity of the brain, brain stem, spinal cord, or peripheral nerves during a medical procedure. Neuromonitoring protects the nervous system by having real time access to any changes in the way your nerves behave and communicate with one another. Neuromonitoring can alert both the surgeon and anesthesiologist of potential injury in real time to allow for preventative modification. Use of neuromonitoring can prevent injuries such as paralysis, muscle weakness, loss of hearing, vision and feeling.
Although the first monitoring of human brain function on an unconscious subject was in the 1930s, the 1980’s was when the practice began developing into a field of its own. During the first 50 years of its existence, any neurophysiologists or surgeons who wanted to trace nerve activity would have to build their own equipment and modify it to fit in the operating room. In 1981 when commercial equipment became available, the specialty began to gain in popularity. In the 2010’s with advances in technology and patient care standards, the practice became mainstream and commonplace in operating rooms worldwide.
So how does it all actually work? Neuromonitoring is performed by a specialty team of a surgical neurotechnologist and a monitoring physician, both who specialize in the nervous system. During a procedure, the neurotechnologist, while being monitored by the physician through telecommunication, delivers electrical impulses to the nervous system using a series of electrodes attached to the wrists, ankles, and scalp.
They also target the muscle groups corresponding to the area of the operation by using subdermal electrodes. The electrodes then record the response to the stimulus in real time and transmit the readings to the neurotechnologist’s screen. Sitting right by the patient’s side during the whole procedure, the neurotechnologist will communicate with the surgeon and anesthesiologist to confirm the integrity of the nervous system.
So, what happens if your physician is recommending neuromonitoring for your upcoming procedure? You will be receiving a phone call from the neuromonitoring team prior to your procedure day to discuss your care and address any questions you may have. When you arrive for your scheduled procedure, you will meet your neurotechnologist. He or she will go over the process with you once again and hopefully you will feel comfortable and relaxed that you will be receiving the highest level of patient care. During the procedure you will likely be put under general anesthesia or monitored anesthesia care, also referred to as MAC. Please see the bottom of this article for more information on this topic. Once you are asleep, the neurotechnologist will place their electrodes and monitor your nervous system until the surgeon is finished. You’ll wake up comfortably recovering in your post-op bed, and the neuromonitoring team will follow up within the next few days to assess your mobility and sensation.
Neuromonitoring is considered the standard of care in today’s operating rooms for neurologic, orthopedic, vascular, cardiothoracic and ENT surgical cases. It has replaced intraoperative wake up testing and has a proven track record of reducing neurological complications from surgical procedures.
Most surgeons have low complication rates and strive for minimal nerve irritation. Nonetheless, having an option to receive neuromonitoring can provide peace of mind to many patients. For those who may feel nervous about an upcoming surgery, they can rest easy knowing the use of neuromonitoring truly is comprehensive patient care at its best.
MAC v General Anesthesia:
Monitored Anesthesia Care, or MAC, means that an anesthesiologist will be administering medications through an IV and maintains control of your consciousness throughout the procedure. You will be asleep and will not remember anything from that point on, though you will maintain ability to breathe on your own without intubation. Recovery may be slightly faster than with General Anesthesia. General anesthesia is completely experience free, meaning you will not hear, feel or remember anything from the procedure. It is also administered by an anesthesiologist; however, your body will be in such a deep state of unconsciousness that your physicians will facilitate control of your airways, breathing and circulation through artificial respirators. It may take slightly longer to recover from, but in instances of outpatient procedures you will still be released the same day.