Pre-operative communication with the surgeon regarding ACNS and ABNM surgery-specific IONM protocols is important to achieve optimal neural protection for the patient.

Regarding the extended use of Neuromuscular Blocking (NMB) agents:

Intraoperative assessment of motor pathway function (MEP) and motor nerve root irritation (EMG) will not be possible during the prolonged pharmacological use of Neuromuscular Blocking agents.

Regarding frequent acquisition of MEPs:

If both the surgeon and anesthetic protocol will allow, it is highly recommended that MEPs are acquired INTRA-operatively at regular intervals during the case. This is done to provide optimal protection of motor pathway function. It is not recommended to only acquire "before and after" MEP data at pre-incision baseline and later at closing.

Regarding evaluation of EEG:

Intraoperative assessment of cortical symmetry and potential ischemic events will not be possible while EEG prolonged suppression (or "near-isopotentiality") is induced systemically or pharmacologically.