WS5.9. Artefacts in Neurophysiologic Intraoperative Monitoring

Intraoperative neurophysiology monitoring (NIOM) is based on neurophysiological examinations that are usually carried out in daily clinical practice. However, there are fundamental differences in NIOM than in clinics due to the environment and the need for accuracy and speed of interpretation. The operating room is a hostile place for neurophysiology recording such us EEG, EMG, and evoked potentials because of there are many sources of electricity that can cause interference and artefacts during recording and will ultimately reduce the accuracy and speed of interpretation of NIOM. Technical error can be happening during NIOM and often cannot be corrected because of aseptic and antiseptics practices has been performed in the field of surgery, therefore one should have troubleshooting strategy and preparation in NIOM to overcome this problem. The knowledge of the recognition of artefacts and trouble-shooting during NIOM becomes very important to maintain patient safety during surgery. More than half of the work on NIOM is to overcome NIOM's artefacts and trouble-shooting to get accurate recording results. This topic will discuss practical ways to deal with artefacts and troubleshooting that are often found in NIOM based on experience and the basics of electricity, including how to reduces signal noise, get better recording results and strategy to get reliable and accurate interpretation of NIOM and overcome technical error. This topic will also discuss the safety of NIOM to prevent iatrogenic injury such us tongue laceration in the use of Trans-cranial MEP, induction of seizure in cortical stimulation and prevent neural tissue injury due to direct stimulation. Keywords: Neurophysiology Intra Operative Monitoring (NIOM), artefacts, troubleshooting.