NEUROMONITORING is a common term used to describe an evidence based patient care provided by Neurophysiologists. The most appropriate term used to refer this field is Intra-Operative Neurophysiological Monitoring(IONM)

IONM is an advanced multimodality neurophysiological tests and evaluation of the functional status of nervous system. In principle, this is a modern approach to patient safety during surgical procedures. The actual procedure is mostly (but not exclusively) carried out inside the Operating Rooms (Surgery) of hospitals at the request and collaboration of Neurosurgeons and Orthopedic surgeons (the Anesthesiologists collaboration is also very important). Therefore, it is a team work to bring out the best of surgical procedure done in the OR, to protect the patient neurologically and to prevent any iatrogenic injury to patient’s nerves, nerve roots, and spinal cord or brain structures. Neuromonitoring also can help identify non-surgical or systemic changes resulting in stroke, ischemia, hypoxia or epilepsy induced neurological changes. So, in principle neurophysiological assessment is performed in anesthetized patient’s right inside the OR during surgery, neurosurgical procedures such as craniotomy to remove tumor, brain surgical procedure that involves epileptic treatments, brain implants or brain mapping procedures to localize the sensory and motor areas in the brain. Other surgical procedures heavily depend on Neuromonitoring for patient safeties are Orthopedic, Vascular and procedures to treat Pain. As a Neurophysiologist, I provide IONM services to several hospitals in the state of California, Nevada and Utah. The most appropriate and qualified provider of IONM is someone with a PhD or M.D in Neurophysiology/Neurology (though there is no such stringent limitation that anyone with a bachelor degree or certification in EPs, EMGs be trained, but the interpretation and reporting can only be done by doctorate/doctor, or someone with ABNM board certification). I have double master’s degree, master’s degree in Bio-Chemistry (MS) and another Research Masters degree in Neurophysiology (M. Phil) which further advanced into my doctorate (PhD) in Neurophysiology. Since 1990, I have been engaged in basic and clinically oriented research work primarily aimed to uncover mechanisms of neuro-degenerative diseases, Degeneration and Neuronal Regeneration in the brain, the ability of nerve growth in the central nervous system. Regeneration and Neuroplasticity is the main focus of my research projects. My research background also crowned by several years of Postdoctoral experience at University of Connecticut (UCONN), UCONN Health Center (UCHC) and a jaunt at the Yale Medical School as young faculty. The medical field alliance and my neurophysiology background further aided me to embrace patient care through Intraoperative Neurophysiological Monitoring, and I said good bye to the mundane and rat race filled academia couple of years ago. As a Neurophysiologist, I now provide IONM services to patients who undergo various surgeries that might pose risks of damages to cranial nerves, sensory and motor pathways, risks of spinal cord or brain damage during surgical procedures that I mentioned above. One of the challenges and lacunae in science and medicine is to take the knowledge after breaking down into simple and understandable to the public, after all, who are we doing all these science, technology or medical work?. Then came the idea of blogging, you will not believe if I say that there is not many scientists or doctors who blog?. Did they really tried through the conventional media in the old days take science and medicine to the mass, the answer is no they did not (except a few scientists?), then how can you expect them to use the modern tool like blogging or internet at their disposal to reach the public, isn’t ironic?. Well, most scientists cannot think of the common people because they simply cannot speak simple language, let alone attitudes?. I am not deterred by those anyways; I am here to do my little part throwing the tiniest pebbles into the Ocean of Science and Medicine.

This Blog is designed, written and maintained by *****Dr. Muni Subramani, M. Phil. Ph.D******

A Solid Rock is not shaken by Wind; The Wise are not moved by praise or blame *****By Sakyamuni BUDDHA******

Wednesday, January 30, 2008

Cardiovascular Surgery (like Cardiopulmanory bypass-CPB) & Neuromonitoring!

The following article demonstrates that neuromonitoring is very useful in cardiovascular surgeries, especially in patients with cerebrovascular diseases.

Intraoperative neuromonitoring in cardiac surgical patients with severe cerebrovascular disease
Alexander Kulik, MD, Rosendo A. Rodriguez, MD PhD, Howard J. Nathan, MD and Marc Ruel, MD MPH
University of Ottawa, Ottawa, Canada, E-mail: akulik@ottawaheart.ca

To the Editor:
Patients with severe cerebrovascular disease are at a high risk of neurologic complications during cardiac surgery, as a result of cerebral embolization or hypoperfusion during cardiopulmonary bypass (CPB). Intraoperative neuromonitoring, including transcranial Doppler ultrasound (TCD) and electroencephalography (EEG), may be particularly useful in patients with cerebrovascular disease.1 We hereby present two cases that illustrate the use of intraoperative neuromonitoring during cardiac surgery in patients with severe cerebrovascular disease.

Posted by drmuni at Wednesday, January 30, 2008

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