Tewari Anurag, Francis Lisa, Samy Ravi N, Kurth Dean C, Castle Joshua, Frye Tiffany, Mahmoud Mohamed
Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, Cincinnati, USA.
J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):84-93. doi: 10.4103/joacp.JOACP_315_17.
Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High-quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia and surgery. Few studies have investigated the IONM team's objective communication with anesthesia providers. We conducted a retrospective review of IONM-related quality assurance data to identify how changes in the evoked potentials observed during the surgery were communicated within our IONM-anesthesia team and determined the resulting qualitative outcomes.
Quality assurance records of 3,112 patients who underwent surgical procedures with IONM (from 2010 to 2015) were reviewed. We examined communications regarding perioperative evoked potential or electroencephalography (EEG) fluctuations that prompted neurophysiologists to alert/notify the anesthesia team to consider alteration of anesthetic depth/drug regimen or patient positioning and analyzed the outcomes of these interventions.
Of the total of 1280 (41.13%) communications issued, there were 347 notifications and 11 alerts made by the neurophysiologist to the anesthesia team for various types of neuro/orthopedic surgeries. Prompt communication led to resolution of 90% of alerts and 80% of notifications after corrective measures were executed by the anesthesiologists. Notifications mainly related to limb malpositioning and extravasation of intravenous fluid.
Based on our institutions' protocol and algorithm for intervention during IONM-supported surgeries, our findings of resolution in alerts and notifications indicate that successful communications between the two teams could potentially lead to improved anesthetic care and patient safety.
术中神经生理监测（IONM）是许多脊柱、血管和颅内手术的护理标准。高质量的围手术期护理需要多个多学科团队的沟通与协作。其中一个多学科服务是术中神经监测（IONM），而其他团队包括麻醉和外科团队。很少有研究调查IONM团队与麻醉提供者之间的客观沟通情况
