Brief , points to be checked in Transcranial electrical Motor evoked potentials {TCeMEP} Before procedure.
checklist may be helpful to ensure that all necessary steps are taken and important considerations are addressed.
Table of contents
Checklist.
Preparation.
Machine.
Stimulating parameters.
Preparation .
- Patient verification showed be verified
- Neurophysiologist /Anesthesiologist can Explain the procedure to the patient.
- Remove any metallic objects that can interfere with the test.
Machine/equipment setup.
- Check the functionality of the Transcranial electrical Motor evoked potentials {TCeMEP} machine.
- Ensure proper calibration of the equipment.
- Verify the proper placement of the corkscrew electrode for stimulation.
Subject Monitoring.
- Monitor vital signs throughout the procedure.
- Ensure proper grounding of the patient to minimize electrical noise.
- Monitor muscle activity {TOF} to ensure relaxation during stimulation.
Stimulation Parameters should checked before delivering current to the patient.
- Set appropriate stimulation parameters {Number of pulses, intensity of current, frequency, pulse duration) based on the patient’s condition and the purpose of the test.
- Confirm that the stimulation parameters adhere to safety guidelines to avoid cortical injury.
Recording TCeMEPs.
- Position electromyography (EMG) electrodes over the target muscle {surgical side}.
- Check the impedance of the electrodes usually preferred <5kΩ.
- Ensure proper amplification and band pass filtering of the EMG signals.
- Record baseline MEP responses.
- Deliver train of pulses / double train pulses { if myelopathy grade III} and record MEP responses.
- Repeat stimulation if needed to obtain consistent responses.
Signal Analysis.
- Analyze MEP waveforms for amplitude, morphology and latency,
- Compare MEP responses between baseline and current findings.
- Document any abnormal findings along with time .
Post-Procedure.
- Document the procedure in the patient’s medical record.
- Clean and sterilize {electrode and probe} according to protocols.{Through CSSD}
Quality Safety.
- Ensure proper documentation of all steps and findings.
- Address any issues or discrepancies encountered during the test.
Safety.
- Adhere to safety guidelines for TCeMEP procedures,{ Bite Block} to avoid tongue laceration.
- Have emergency protocols in place in case of complications.
Conclusion.
This checklist should be customized based on the specific surgical protocols and requirements of the facility where the MEP testing is being done.
Related to this article.
https://neurointraoperative.com/wp-admin/post.php?post=1970&action=edit
https://www.healthline.com/health/motor-evoked-potential-mep-test
Questions.
Why we should know about checklist before performing IONM ?.
Why bite block is mandatory before Motor Evoked Potential?.
Should we concern about neuro-anesthesia?.
What is the meaning , good quality of motor and sensory responses to interpret properly?.
As a surgical neurophysiologist should also concern to check correct side of procedure?.