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Procedural / Technique
neuro
High-impact pattern

Prone Spine Surgery with Intraoperative Neuromonitoring (IOM)

Anesthesia management to keep SSEPs, MEPs, and the spinal cord safe in the prone position

Prone spine surgery with IOM demands a TIVA-based anesthetic (no volatile, no paralysis during MEP), MAP ≥85 mmHg in adults, a free abdomen for venous drainage, and immediate response to SSEP amplitude ↓>50% / latency ↑>10% or MEP amplitude ↓>80%.

If you forget

TIVA + no NMB for MEP — propofol/ketamine + remifentanil, quantitative TOF, no volatile

Board trap
Leaving a volatile agent or persistent neuromuscular blockade on during MEP acquisition — both abolish the motor response and masquerade as cord injury, while a real alarm gets blamed on artifact.

Key numbers

  • SSEP alarm: amplitude drop >50%
  • SSEP alarm: latency increase >10%
  • MEP alarm: amplitude drop >80%
  • MAP goal ≥85 mmHg (adolescent/adult); 20% above baseline (child)
  • CSF pressure target <10 cm H2O (high-risk aortic/spine cases)
  • TIVA-only: switch off volatile the moment an EP alarm fires
Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: SNACC Neuroanesthetic Emergencies 2020 · AAA Spinal Cord Ischemia 2022 · SVS Perioperative Vascular Care 2022 · AAA Perioperative Care Review 2022

Re-review cadence: 12 months from reviewed date.

Drill this as a SOE stem →

Related on BoardsBridge

Card ID: prone-iom · Path: aba.neuro.spine.prone-iom

Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment. See editorial process and the sitemap entry for this card.