Intraoperative neurophysiological monitoring (IOM) using evoked potentials and electromyography has become commonplace during many surgical procedures. It is used to identify and map areas of the central nervous system or monitor for neurological insults. It is believed to improve intraoperative decision-making and reduce neurological risk. A recent evidence-based review by the American Academy of Neurology and American Clinical Neurophysiology Society has reinforced its role during surgery on the spine. In particular, it can identify early neural dysfunction due to ischemia that could signal the need for improvement in blood flow and reduction of injury. Most anesthesiologists are now, with a varying degree, familiar with the need for a general anesthetic that is supportive of monitoring (e.g., reduced reliance on inhalational agents and neuromuscular blocking agents) with some of these monitoring techniques (especially motor evoked potentials). What anesthesiologists may not be familiar with is that the current monitoring process requires...

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