Our recommendations for anesthesia during each case depend on what type of modalities are being run, which are dictated by the type of procedure being performed and surgeon request. The following are the most commonly requested protocols:
TIVA: Gases obliterate SSEP’s and MEP’s due to their mode of action, which hinders the transmission of electrical impulses across a synapse. In order for accuracy in MEP’s, EMG, and tEMG, we request that the patient not be relaxed at the time of recording and that no gases are used during the procedure.
Less that ½ MAC Gas (sevo is preferred) and Short Acting Paralytic: IF TIVA is for some reason not possible, we will request the above mentioned protocol, which should allow for accurate neurological responses to SSEP’s, MEP’s, EMG’s, and tEMG’s. Nitrous Oxide enhances the effect of the other gases (and therefore obliterates neurological responses for SSEP’s and MEP’s) and we prefer it NOT be used.
Short Acting Paralytic: If the case only requires EMG or tEMG, we only request short acting paralytic with no requests pertaining to gases.