This course consists of movie lectures by Tod Sloan, MD PhD, who is an anesthesiologist and practicing neuromonitoring profession for many years. Dr Sloan's lectures are fast paced and easy to follow and he covers many aspects of monitoring and the impact of anesthesia, as well as the perspective of the anesthesiologist. Dr Sloan is especially well qualified to provide guidance to neuromonitoring professionals who are seeking to have good relationships with the anesthesia providers with whom they work. This course is a very good continuing education course for CNIM professionals, for use in recertification.

20 ACE Credits are give for successful completion of this course. There are no additional books or materials needed. Final exam = 100% of course grade. Passing score 80% or higher.


IONM 104:Anesthesia in IONM


Tod Sloan, MD, MBA, PhD


Lecture 1: Perioperative Medication

  • Recognize the basics of the medical practice of Anesthesia
  • Define Anesthesia team providers including:
    • Anesthesiologists
    • Certified Registered Nurse Anesthetists (CRNA)
    • Anesthesia Assistants (AA)
    • Anesthesia Technicians
  • Describe Peri-Operative Management including:
    • Describe preoperative issues
      • Define medical condition patient
        • History
        • Co-morbidities
          • Heart Disease (MI, Coronary Artery disease, HTN)
          • Pulmonary Disease (Asthma, COPD)
          • Liver Disease
          • Renal Disease
          • Pregnancy
          • Usual medications
          • Premedication (sedation, analgesia, antiboiotics)
          • Current health problem
          • Medications
          • Labs
        • Physical Exam (Surgical Consultation)
          • The Anesthesia Machine
          • Monitors
          • Vital Signs
          • Airway
          • Heart and Lungs
          • Remainder
          • Physical Deformities
          • Anesthesia risks
          • IV Access
        • ASA class
          • 1 Normal Healthy
          • 2 Mild systemic disease
          • 3 Sever systemic illness
          • 4 Constant thread to life
          • 5 Moribund, unlikely to survive
          • E-Emergancy - not fully prepared
        • Discussion and Consent
      • Define how patient’s readiness for surgery is judged including:
        • Classification of surgery type:
          • Elective Procedure
          • Urgent Procedure
          • Emergency Procedure
        • Possible stress of surgery for patient
        • Physiological, hormonal and inflammatory stresses
        • Recognize the potential causes of perioperative death
      • Recognize specific anesthetic issues for the patient
    • Describe Intraoperative issues including:
      • Recognize medical management of anesthetized patient during surgery including:
        • Drugs needed and planned
        • Adjunct drugs needed to adjust physiology
        • Emergency drugs
    • Recognize physiological management of the anesthetized patient during surgery including:
      • Phases of Surgery
        • Preoperative Assessment
        • Preparation
        • Induction
        • Maintenance
        • Wake Up
        • Recovery
    • Recognize issues with positioning the patient during anesthesia
    • Recognize anesthetic agents and levels during surgery
    • Recognize special considerations when the patient is under anesthesia (some patients have more issues with anesthesia than others-what are these types of issues?)
    • Postoperative issues
      • Recognize medical management considerations of the patient post surgery
        • Medical - Legal Issues
        • Most common: Teeth, lip, tongue damage from intubation of MEP
        • Brain Damage
        • Nerve Injury
        • Awareness
        • Eye Injury
        • Medical errors, Nerve Blocks, Anesthesia Machine
    • Recognize the need for pain management post surgery

Lecture 2: Drugs and Components of Anesthesia

    • Define anesthesia including:
      • Forms of anesthesia
        • Local/Monitored Anesthesia Care (MAC*)
          • Local Anesthesia in Craniotomy
            • MAC minimal to no sedation or analgesia for unimpeded cognitive function testing
            • Asleep-Awake-Asleep technique
            • Patient comfort extremely important
            • Good local anesthesia is key
        • Awake or Dissociative Anesthesia
        • Regional Anesthesia (Nerve block)
        • General Anesthesia
          • Goals include:
            • Unconsciousness
            • Lack of awareness
            • Lack of pain response
            • Immobility
            • Hemodynamic stability
            • Special management techniques
    • Types of drugs and mechanisms of action
      • Inhalational agents
        • Halothane, Enflurane, Isoflurane, Sevoflurane, Desflurane, Nitrous Oxide
      • Intravenous agents
        • Propofol, Etomidate, Midazolam, Dexmeditomidine for sedation
        • Opioids: Fentanyl, Sufentanil, Remifentanil for analgesia
        • TIVA
        • Neuromuscular blocking agents
    • implication for IONM
    • Working with anesthesia
      • Analgesia (Pain relief)
      • Sedation (Amnesia)
      • Muscle relaxation
    • Recognize surgical changes both from direct or indirect insult
    • Recognize anesthetic related effects including:
      • Anesthetic depression of nervous tissue
      • Indirect changes due to hypotension
    • Recognize physiological changes including:
      • Benign neural alteration - hypothermia
      • Potentially injurious - ischemia
    • Recognize technical alterations in monitoring
    • Recognize details of mechanisms of different drugs and how they interact with IONM modalities

Lecture 3: Anesthesia in Sensory Evoked Potentials

    • Recognize Anesthetic Targets
    • Recognize changes in monitoring dues to:
      • Direct or indirect insult
      • Anesthetic related effects
        • Recognize changes in responses and correlate with anesthetic related changes in physiology of patient
      • Physiological changes
      • Technical alterations in monitoring

Lecture 4: Anesthesia in Motor Evoked Potentials

    • Recognize Anesthetic Targets
    • Recognize changes in monitoring dues to:
      • Mechanisms of anesthesia such as:
        • Synaptic inhibition
        • Thalamic blocking
        • Spinal cord blocking
        • Blocking of neuromuscular junction
        • Physiological effects
      • Anesthetic and Spinal Reflexes (H Refelx and MEP)
        • Propofol vs Sevoflurane
      • Motor Evoked Potential pathway
      • Inhalational agents
        • I waves and D waves
        • CMAP
        • Nitrous Oxide vs other inhalational agents
      • Analgesia Agents
      • Muscle relaxing agents

Lecture 5: Physiology of Anesthesia

    • Categorize changes due to Anesthesia including:
      • Anesthesia
        • Bolus effects
        • Shifting concentrations
        • Secondary changes
      • Physiology
        • Ischemia
          • Infarction
          • Penumbra
        • Neural functioning
        • Temperature
          • Hypothermia
        • Ventilation
          • Oxygenation
          • Ventilation
        • Organ perfusion
          • Blood pressure
          • Local factors
        • Circulating Blood Volume
        • Intracranial Pressure
        • Blood Viscosity
        • Electrolytes
        • Metabolic Substrates
          • Glucose
      • Positioning
      • Surgical
        • Mechanical
        • Vascular
          • Vasospasm
          • Carotid retraction
          • Arm tourniquet
          • Femoral artery ischemia
          • Deliberate hypotension
          • Autoregulation variables
          • Determinants of Spinal cord blood flow
            • External supply
            • Vascular topography
            • Microcirculary control
      • Time to electrical failure including:
        • Cerebral cortex 20 sec
        • Spinal grey matter 1-2 mins
        • White sensory 7-18 mins
        • White motor 11-17 mins
        • Peripheral nerves 20-45 mins
      • Technical issues
  • Lecture 6: Anesthesia in Spine Surgery and IONM
  • Lecture 7” Anesthesia in Brain Surgery and IONM
  • Additional Reading Materials
      • Lecture 8 Anesthesia Updates by Todd Sloan MD, PhD


Course grade:

  • Final exam - 100% Passing Score 80% or higher


Click here to download Course Outline, Goals, and Objectives PDF Document