![MedLecturesMadeEasy](/img/default-banner.jpg)
- 829
- 8 804 180
MedLecturesMadeEasy
United States
Приєднався 15 лип 2015
Evoked potentials in surgical neuromonitoring and effects of anesthesia
This is a slide on evoked potentials used as neuromonitoring in surgery as well as the effects of anesthesia on the evoked potentials.
ADDITIONAL TAGS:
Evoked potentials
Stimulus
Pathways monitored
Relevant surgeries
Effect of inhaled anesthetics
Brainstem auditory evoked potentials (BAEP)
Acoustic → BAEP electrode placed on scalp
Cochlea → cochlear nerve, through the cochlear nucleus (CN VIII) → superior olivary complex → lateral lemniscus → inferior colliculus in the midbrain → medial geniculate body → auditory cortex
Posterior fossa surgeries
Minimal
Motor evoked potentials (MEP)
Magnetic stimulation or transcranial electrical stimulation of the motor cortex → MEP recorded from muscles
Motor cortex
Brainstem
Descending motor pathways
Peripheral nerve
Spine
↓ amplitude and ↑ latency
Total intravenous anesthesia is preferred but can use up to 0.5 MAC
Somato- sensory evoked potentials (SSEP)
An electrical stimulus is applied to the peripheral nerve → SSEP recorded from brain or spinal cord
Upper extremity: median or ulnar nerve
Lower extremity: posterior tibial nerve
Peripheral nerve
Dorsal root ganglion
Posterior column of the spinal cord
Cardio- vascular;
Endo- vascular;
Intra- cranial;
Spine
↓ amplitude and ↑ latency
Can use MAC of 0.5-1.0 during measurements
Visual evoked potentials (VEP)
Light flash or pattern stimulus → VEP electrode on visual cortex
Retina, optic nerve (CN II), optic chiasm, optic radiations, and occipital cortex
Ophthal-mic
↓ amplitude and ↑ latency
Agent
SSEP amplitude
MEP amplitude
Comments
Isoflurane; Sevoflurane; Desflurane
↓
↓
SSEP usually recorded at less than 1 MAC, MEP less than 0.5 MAC
N2O
↓
↓
Similar to isoflurane, synergistic when combined with halogenated agents
Propofol
↓
↓
SSEP and MEP usually recorded at anesthetic doses but MEP may be lost at high doses
Barbiturates
↓
↓
Similar to propofol; limited experience with MEP
Opioids
Minimal
Minimal
SSEP and MEP usually recorded even at high doses
Etomidate
↑ at low doses - ↓ at higher doses
↑ at low doses - ↓ at higher doses
Enhancement of SSEP and MEP seen at low doses, depression at very high doses
Ketamine
Minimal, ↑ at low doses
Minimal, ↑ at low doses
Enhancement SSEP and MEP seen at low doses
Benzo- diazepines
Minimal at low doses
Minimal at low doses, prolonged ↓ at higher doses
SSEP and MEP usually recorded with small doses for amnesia
Dexmede- tomidine
Minimal
Minimal - ↓ at higher doses
SSEP and MEP usually recorded at low doses but MEP lost at higher doses
Lidocaine
Minimal
Minimal
Can be used as intravenous supplement in SSEP and MEP
Anesthesia has greatest effects on MEP and SSEP
Inhalational agents have greater effects on neuromonitoring than IV drugs
ADDITIONAL TAGS:
Evoked potentials
Stimulus
Pathways monitored
Relevant surgeries
Effect of inhaled anesthetics
Brainstem auditory evoked potentials (BAEP)
Acoustic → BAEP electrode placed on scalp
Cochlea → cochlear nerve, through the cochlear nucleus (CN VIII) → superior olivary complex → lateral lemniscus → inferior colliculus in the midbrain → medial geniculate body → auditory cortex
Posterior fossa surgeries
Minimal
Motor evoked potentials (MEP)
Magnetic stimulation or transcranial electrical stimulation of the motor cortex → MEP recorded from muscles
Motor cortex
Brainstem
Descending motor pathways
Peripheral nerve
Spine
↓ amplitude and ↑ latency
Total intravenous anesthesia is preferred but can use up to 0.5 MAC
Somato- sensory evoked potentials (SSEP)
An electrical stimulus is applied to the peripheral nerve → SSEP recorded from brain or spinal cord
Upper extremity: median or ulnar nerve
Lower extremity: posterior tibial nerve
Peripheral nerve
Dorsal root ganglion
Posterior column of the spinal cord
Cardio- vascular;
Endo- vascular;
Intra- cranial;
Spine
↓ amplitude and ↑ latency
Can use MAC of 0.5-1.0 during measurements
Visual evoked potentials (VEP)
Light flash or pattern stimulus → VEP electrode on visual cortex
Retina, optic nerve (CN II), optic chiasm, optic radiations, and occipital cortex
Ophthal-mic
↓ amplitude and ↑ latency
Agent
SSEP amplitude
MEP amplitude
Comments
Isoflurane; Sevoflurane; Desflurane
↓
↓
SSEP usually recorded at less than 1 MAC, MEP less than 0.5 MAC
N2O
↓
↓
Similar to isoflurane, synergistic when combined with halogenated agents
Propofol
↓
↓
SSEP and MEP usually recorded at anesthetic doses but MEP may be lost at high doses
Barbiturates
↓
↓
Similar to propofol; limited experience with MEP
Opioids
Minimal
Minimal
SSEP and MEP usually recorded even at high doses
Etomidate
↑ at low doses - ↓ at higher doses
↑ at low doses - ↓ at higher doses
Enhancement of SSEP and MEP seen at low doses, depression at very high doses
Ketamine
Minimal, ↑ at low doses
Minimal, ↑ at low doses
Enhancement SSEP and MEP seen at low doses
Benzo- diazepines
Minimal at low doses
Minimal at low doses, prolonged ↓ at higher doses
SSEP and MEP usually recorded with small doses for amnesia
Dexmede- tomidine
Minimal
Minimal - ↓ at higher doses
SSEP and MEP usually recorded at low doses but MEP lost at higher doses
Lidocaine
Minimal
Minimal
Can be used as intravenous supplement in SSEP and MEP
Anesthesia has greatest effects on MEP and SSEP
Inhalational agents have greater effects on neuromonitoring than IV drugs
Переглядів: 271
Відео
Neuromuscular blockers in myasthenia gravis and Lambert-Eaton
Переглядів 318Місяць тому
Neuromuscular blockers in myasthenia gravis and Lambert-Eaton
Neuraxial procedures and anticoagulation
Переглядів 3595 місяців тому
Neuraxial procedures and anticoagulation
Dominant EEG waveforms associated with common anesthetic agents
Переглядів 1785 місяців тому
Dominant EEG waveforms associated with common anesthetic agents
Brachial plexus and ultrasonic planes for nerve block
Переглядів 3547 місяців тому
Brachial plexus and ultrasonic planes for nerve block
Thyroid-related laboratory abnormalities
Переглядів 7017 місяців тому
Thyroid-related laboratory abnormalities
Medical conditions that dysregulate acetylcholine receptors
Переглядів 4788 місяців тому
Medical conditions that dysregulate acetylcholine receptors
Pontine syndromes caused by ischemic infarcts
Переглядів 8488 місяців тому
Pontine syndromes caused by ischemic infarcts
Lung cancer (mechanism of disease)
Переглядів 2 тис.11 місяців тому
Lung cancer (mechanism of disease)
Primary amenorrhea (mechanism of disease)
Переглядів 6 тис.Рік тому
Primary amenorrhea (mechanism of disease)
Intracerebral hemorrhage (mechanism of disease)
Переглядів 2,5 тис.Рік тому
Intracerebral hemorrhage (mechanism of disease)
Subarachnoid hemorrhage (mechanism of disease)
Переглядів 839Рік тому
Subarachnoid hemorrhage (mechanism of disease)
Penetrating neck trauma (mechanism of disease)
Переглядів 687Рік тому
Penetrating neck trauma (mechanism of disease)
Ischemic stroke (mechanism of disease)
Переглядів 1,2 тис.Рік тому
Ischemic stroke (mechanism of disease)
Penetrating abdominal trauma (mechanism of disease)
Переглядів 2,8 тис.Рік тому
Penetrating abdominal trauma (mechanism of disease)
Penetrating chest trauma (mechanism of disease)
Переглядів 2,1 тис.Рік тому
Penetrating chest trauma (mechanism of disease)
Type IV hypersensitivity (mechanism of disease)
Переглядів 454Рік тому
Type IV hypersensitivity (mechanism of disease)
Schistosomiasis (mechanism of disease)
Переглядів 3,8 тис.Рік тому
Schistosomiasis (mechanism of disease)
Endemic fungal infections: Histoplasmosis, (Para)Coccidioidomycosis, Blasto (mechanism of disease)
Переглядів 1,4 тис.Рік тому
Endemic fungal infections: Histoplasmosis, (Para)Coccidioidomycosis, Blasto (mechanism of disease)
Type III hypersensitivity (mechanism of disease) with examples
Переглядів 451Рік тому
Type III hypersensitivity (mechanism of disease) with examples
Serotonin syndrome (mechanism of disease)
Переглядів 2,2 тис.Рік тому
Serotonin syndrome (mechanism of disease)
Just took my test today. Thank you for this information!
You really helped me. Thank you
Oh god i just found out about this im scared how common is it😭?
❤
Cherry pit contains cynaide So cherry red skin ❤❤❤
Can u share the flow chart? The link maybe or else
Can u share the flow chart? The link maybe or else
Can u share the flow chart? The link maybe or else
Thank you so much
I’m excited I’m cured from herpes thanks too #DrOseghaleSundayHerbalHome 🏡
Great❤
Can you fix it
Why are you speaking so fast??
I HAVE A PRESENTATION TOMORROW AND THANK GOD I FOUND YOUR VIDEO.......THIS IS THE MOST BRILLIANT CHART FOR LEARNING THYROTOXICOSIS OUT THERE
Thank you for this perfect video🙏🏼
My ex fiancee Died from This and he at the time of his death threw up well so much orange fluids clear orange fluid just pulled and pulled and pulled and pulled pout of his mouth and nose and I had to use pillows to soak This up to resuscitate him which was unsuccessful I really like some answers
Can ocd be completely cured?
Very nice.very neatly explained.
this video is very awesome....,this channel is very underrated..keep going man❤
Great summary! thank you ❤
The human papillomavirus infects immature squamous cells and viral replication takes place there, the cervix has this metaplastic epithelium vulnerable to HPV, the pathogenesis is characterized why does the virus produce proteins such as E7 that binds to RB and E6 that inhibits P53, useful molecules to arrest the cell cycle but the virus takes them to a state of proliferation and causes lesions called cervical intraepithelial neoplasias that can be low grade or high grade that can cause cervical carcinoma
So this is why I have GERD now after my surgery a month ago 😢 seeing ENT and gastrointestinal doc now it’s horrific
Not true it is not irreeversable simple google search and pub med papers talk about this and methionine cycle resumes after about 4 days
what is ulcerative dyspepsia
My blood work showed I had tear drop & oval shaped cells, what can that mean?
Erythema migrain
what if my MRI showed empty sella and intracranial hypertension ? should i still get a spinal tap i suffer from tinnitus and neck pain :/
So useful! Thank you sir 💪
You forgot “causes dementia in elderly patients, with clear mental impairment becoming noticeable within 6-12 months post-exposure, and severe debility within 3-5 years.”
Best video
was this supposed to be super sped up?
was this supposed to be super sped up?
Thanks 😮
will tracheostomy reduces dependency on ventilator?
Thanks, a nice quick comprehensive breakdown of polyneuropathy. I "might" have Axonal neuropathy, as CIDP has apparantly been ruled out, so now testing for Axonal. Runner's dystonia was also a possible diagnosis but none of the treatments helped, just horrible side-effects.
My 8 years old girl suffering from bladder disfunction what is the treatment please suggest
I have always believe they have a cure and that there is too much money to be made so they don't give it to people hopefully I am proved wrong some day
Thank you
The whole video is made in alien language
My blood pressure was low….
I was diagnosed with adenomyosis last month... Im just 22 and no kids yet... Maybe i will never be a mother which is heartbreaking 💔
Shir-mer test not schry-mer test
Sho-grens not Shro-gen
How can someone download this shorts?
What is adnexal mass means
Amazing is there another video on nephrotic syndrome?
I enjoy watching your videos
Thank you. I was diagnosed with osteoporosis last year, and this year, I was diagnosed with hyperthyroidism. There's not much I can do about any of it other than change my diet to low iodine food. Which means not eating very much, and many of the foods I ate for osteoporosis I can not eat with hyperthyroidism. My life is in God's hands.
What a bunch of crap. Made by a group of people so that they’re always in advantage compared to the poor unfortunate soul that’s trapped in their “sick test”. How can people tolerate such insanity? One man judging another because he feels he has the right to do so? Man these people have never had their teeth knocked out while they were teens for sure otherwise they’d know what truly dangerous consequences for one’s behaviour meant.
The nightmares are brutal! Better than waking up on my kitchen floor covered in piss and puke with no recollection of getting there though..