Abstract

Severe neurological complications can occur in approximately 1% of spine surgery patients, often resulting from spinal cord or nerve injury due to compression, traction, or ischemia. Intraoperative neurophysiological monitoring (IONM) is utilized during spine surgeries to rapidly detect potential neural compromise and prevent permanent neurological damage. Optimal anesthetic management during IONM presents a challenge, as anesthetic agents can significantly influence the reliability and quality of neuromonitoring signals. Total intravenous anesthesia (TIVA) is generally preferred to minimize interference with evoked potentials.

This case described an episode of delayed emergence following an anterior cervical discectomy and fusion with IONM performed under a combined anesthetic regimen of intravenous anesthesia and low-dose sevoflurane (<0.5 minimal alveolar concentration (MAC)). Although IONM signals remained stable throughout the procedure, baseline recordings were obtained while volatile anesthetic was present, raising concerns about their reliability. Additionally, as MAC is variable, at 69 years old with a 1% expired concentration of sevoflurane, the MAC concentration likely exceeded >0.5, potentially rendering our motor evoked potentials (MEPs) unreliable. In this case, when the patient was not spontaneously recovering, neurological compromise was considered as a differential diagnosis. Thus, highlighting the clinical implications for anesthetic management during procedures requiring IONM.

Author Details

Megan N. Duncan, BSN, RN, SRNA: Megan anticipates completion of the nurse anesthesia track of the Doctor of Nursing Practice (DNP) program at Samford University on May 02, 2026. Her DNP project is: Neuromonitoring Efficacy Based on Intraoperative Anesthetic Technique. She plans to begin clinical practice following graduation at USA Health Providence Hospital in Mobile, Alabama. Her primary areas of interest include cardiac, regional, trauma, and emergency anesthesia. Prior to entering the nurse anesthesia program, her critical care experience included two years in the Medical Intensive Care Unit and three years in the Neuro Intensive Care Unit at USA Health University Hospital. She completed her Bachelor of Science in Nursing at the University of South Alabama in 2018. She is currently engaged to Aaron Thompson and enjoys golfing with family and friends outside of her professional pursuits.

David Sanford, DNP, CRNA: David began his healthcare career as a paramedic/firefighter, gaining valuable experience in EMS before pursuing nursing and spending several years in the emergency department. Sanford was honored to be part of the second cohort in Samford University's nurse anesthesia program. Teaching has always been integral to his career, helping paramedic classmates learn EKG interpretation. Over the years, teaching, drawing, and explaining have continued to parallel his clinical work. Sanford's wife is a graduate of Moffett & Sanders School of Nursing. They have two children and serve the Lord at a local church in Birmingham. One of his favorite moments is finishing class and walking across the beautiful campus.

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Intraoperative Neurophysiological Monitoring, Somatosensory Evoked Potentials, Motor Evoked Potentials

Advisor

Terri M. Cahoon

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2026-01-21

Full Text of Presentation

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Additional Files

Abstract.pdf (153 kB)

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