The Development of an Evidenced-Based Guideline for the Anesthetic Management of Surgical Cases Utilizing Evoked Potential Monitoring

Recent increases in the prevalence of neuromonitoring cases have contributed to the utilization of evoked potential (EP) monitoring during surgery. Evoked potentials are electrical signals measured in response to a stimulus. Intraoperative neuromonitoring is used to alert the surgeon, anesthesia provider, and neuromonitoring technician of changes before permanent nerve injury occurs. There are many factors that can affect neuromonitoring quality including hypothermia, hypotension, positioning, anemia, and anesthesia medications. The latter is especially important since certain anesthetic medications can have a profound inhibitory effect on the nervous system, leading to decreased amplitude and prolonged latency of EP signals. As a result, anesthetic agents negatively affect neuromonitoring and the technician’s ability to measure EP signals that can alert the surgeon of potential injury to the patient. Total intravenous anesthesia (TIVA) is a type of general anesthesia that utilizes only intravenous medications administered by infusion or bolus. This anesthesia technique can provide safe and optimal conditions for effective EP signal monitoring. Despite the widespread use of TIVA for EP monitoring surgical cases, significant variance in this technique existed among anesthesia providers at a tertiary care center in central Illinois. A guideline was implemented at the host facility that focused on current best practice recommendations in anesthesia management for surgical cases requiring EP monitoring. The guideline was implemented via a PowerPoint presentation along with a thirteen-question post-implementation survey. Results indicated overall provider acceptance of the TIVA guideline for EP cases and demonstrated that the presentation and guideline were effective tools that could aid in the facility’s ability to administer optimal anesthesia. As a result, the continued use of the guideline has the potential to improve patient safety, ensure reliable results, and optimize outcomes in patients undergoing EP surgical procedures