Technical Parameters, Artifacts, and Quality Assessment of Intraoperative Evoked Potentials

Summary

Monitoring personnel should consider techniques to be flexible. A variety of options are available for specific evoked potential (EP) techniques. Somewhat different techniques should be applied whenever monitoring situations require such variation in technique. Informed users should understand the various ways in which such flexibility of technique can be helpful.

Stimulus site, type, rate, recording site, filter, and other technical parameters can be altered to best suit a particular patient’s circumstances. Averaging can also be performed in several ways. During the baseline portion of an operation, the monitoring team should choose the technique that best suits the particular patient and procedure.

Artifacts and other technical problems are common in the operating room. The monitoring personnel should understand their own equipment and the artifacts present in the operating room so that they can identify the technical problems and minimize them. The monitoring team can assess the adequacy of their own recordings by applying some general quality-assurance standards, assessing reproducibility, and noisiness of the recordings. The overall technical goal of monitoring should be the rapid production of high-quality EP signals, while minimizing baseline variability in latency and amplitude of the major EP peaks. Knowledgeable users should be able to achieve this technical goal in most cases.