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Friday, September 5, 2008

Neuromonitoring Signal Changes during Spinal Epidural Hematoma?

A&AInternational Anesthesia Research Society
oh yes, 
there are few non-surgically induced damages that might go unnoticed in the absence of intraoperative neuromonitoring such as ischaemia, hematoma, stroke and so on...?.
 The following work demonstrates the timely detection of epidural hematoma by neurophysiological wave form changes.
the disappearance of evoked potentials and the subsequent appearance of paraplegia in our patient was unlikely to be caused by the epidural LA, but probably by the occurrence of the spinal epidural hematoma as a complication of epidural catheterization.

Acute spinal cord dysfunction was revealed by INM, then elucidated by imaging of the spine. The whole sequence of events led to timely urgent neurosurgical intervention which resulted in complete restoration of motor and sensory functions.

Our patient’s case supports the value of evoked-potential monitoring during spinal surgery.
This case and previous work offer arguments that evoked potentials are relatively insensitive to epidural LAs, but nevertheless we suggest that neuraxial LAs better be avoided in cases in which INM is used.