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As a fundamental tenet of medical ethics, "Primum Non Nocere" or "First, Do No Harm" serves as a guiding principle for doctors. In the context of surgery, this principle is paramount. Intraoperative Neuromonitoring (IONM) is a crucial tool that embodies this principle, ensuring that surgeons can perform complex procedures while minimising the risk of harm to patients.
Synopsis
IONM: The Co-Pilot in the Operating Room
Think of IONM as a co-pilot on a flight, constantly monitoring the plane's vital systems and alerting the pilot to any potential dangers. Just as a co-pilot ensures the safety of passengers, IONM ensures the safety of patients during surgery.
IONM in Modern Surgery
IONM has become a standard for most brain and spinal surgeries where there is a risk of serious neurological deficits. This is because IONM provides real-time feedback on nerve function, allowing surgeons to identify potential issues and take corrective measures during surgery. By taking these corrective measures, the risk of serious and permanent damage to the nervous system is minimised or negated, ultimately protecting patients from debilitating neurological injuries and improving their chances of full recovery.
How IONM is Performed?
IONM is a multidisciplinary effort, involving a team of experts, including a neurophysiologist, neurologist, anaesthetist and surgeon. The process involves:
- Pre-operative planning: Identifying high-risk areas and developing a customised monitoring plan.
- Electrode placement: Strategically placing electrodes on the patient's body to record nerve activity.
- Signal acquisition: Continuously monitoring and recording nerve signals during surgery.
- Real-time analysis: Interpreting and analysing data to identify potential risks and alert the surgeon.
IONM Techniques
Several techniques are used in IONM, including:
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Electroencephalography (EEG): Monitoring brain activity to assess cerebral function.
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Somatosensory Evoked Potentials (SSEP): Evaluating sensory nerve function and spinal cord integrity.
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Transcranial Motor Evoked Potentials (tcMEP): Assessing motor nerve function and spinal cord integrity.
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Brainstem Auditory Evoked Potentials (BAEP): Monitoring brainstem function and auditory nerve integrity.
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Electromyography (EMG): Recording muscle activity to assess nerve function.
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Nerve Action Potential (NAP): Directly monitoring nerve activity.
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Direct Cortical and Subcortical Stimulation: Stimulating the brain directly to identify and assess key functional areas such as speech and motor regions.
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Awake Testing: Performing neurological assessments while the patient is awake and alert.
IONM is a powerful tool that embodies the principle of Primum Non-Nocere, ensuring that surgeons can perform complex procedures while minimising the risk of harm to patients. Just as a co-pilot is essential for a safe flight, IONM is essential for a safe and successful surgery.
FAQ's
IONM is commonly used in neurosurgical and spinal surgeries.
IONM is minimally invasive, using electrodes to monitor nerve activity.
IONM provides real-time feedback on nerve function, allowing surgeons to adjust their approach and prevent damage.
No, IONM can be used in any surgery where nerve damage is a concern.
IONM benefits patients by reducing the risk of nerve damage, promoting optimal outcomes, and enhancing patient safety.
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