Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 800 - файл

Close collaboration with anesthesia providers is essential to safe and effective use of IONM.Long-acting neuromuscu­lar blockade must be avoided in order to allow for detection of EMG activity. Use of lubricating ointments on the ETT should also be avoided. Pooling of saliva in the glottis can interfere with the function of the recording electrodes and should be managed with suction when necessary. Use of an anticholinergic drying agent may be helpful toward preven­tion of pooled secretions. At the time of initial intubation, the surgeon should be present to facilitate and conrm correct placement of the ETT with the electrodes situated at the level of the glottis. Displacement of the ETT may occur with posi­tioning the patient into full neck extension, with translation as much as 2cm into and 3cm out of the airway after intuba­tion in a neutral position [67]. Additionally, rotation of the ETT may occur, disrupting the extent of vocal cord contact with the recording electrodes. Conrmation of appropriate ETT placement should therefore occur after patient position­ing. Use of a video-assisted laryngoscope may be especially helpful in visually conrming proper placement of the ETT (Fig. 6.4). Alternatively, respiratory variation may be observed on the neuromonitoring system, conrming contact of the recording electrodes with the glottis [68]. Respiratory variation appears as spontaneous saw-toothed shape wave­forms between 30 and 70 μV (Fig. 6.5). This observation should take place after short-acting paralytic has worn off and before the patient enters a deep plane of anesthesia, tim­ing which requires close collaboration and communication