Anaesthesiology Considerations in Surgery with Intraoperative Neurophysiological Monitoring
DOI:
https://doi.org/10.25751/rspa.48855Keywords:
Anesthesia, General, Anesthetics, Evoked Potentials, Intraoperative Neurophysiological Monitoring, Neurosurgical ProceduresAbstract
Intraoperative neurophysiological monitoring allows real-time assessment of nervous structure function during surgery and identification of reversible changes before they progress to permanent injury. Its interpretation depends on the anaesthetic regimen and on the physiological condition of the patient. This narrative review gathers the evidence on the influence of pharmacological agents and physiological variables on the different recording modalities and proposes an anaesthetic approach oriented towards clinical practice. The search was conducted in PubMed up to February 2025, and 43 studies were retained. Anaesthetic agents depress evoked potentials in a manner dependent on the drug, the dose and the number of synapses in the monitored pathway, with cortical and muscle responses being the most susceptible. Total intravenous anaesthesia with propofol and remifentanil is the technique most favourable to signal preservation, particularly when motor evoked potentials are monitored. Stability of the anaesthetic plan and control of blood pressure, ventilation, temperature and haemoglobin concentration are equally decisive. The response to a signal change requires a structured and multidisciplinary approach, with communication between the neurophysiology, anaesthesia and surgical teams.
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Copyright (c) 2026 João Carlos Leote Rebocho, Marta Baptista, Maria Batista, António Hick-Perez, Ricardo Calhau
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