International Journal For Multidisciplinary Research

E-ISSN: 2582-2160   •   Impact Factor: 9.24

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Electrophysiological Monitoring During Brain Surgery Under General Anaesthesia: Principles, Anaesthetic Interactions, and Clinical Practice- Review article

Author(s) Dr. Mohit Aggarwal, Prof. Dr. Vaskar Majumdar, Dr. Biswajit Sutradhar, Dr. Ranjit Reang, Dr. Joydeep Debnath
Country India
Abstract Intraoperative neurophysiological monitoring (IOM) has become an indispensable adjunct to neurosurgical procedures performed under general anaesthesia. By providing real-time functional assessment of neural pathways at risk, IOM enables the surgical team to detect and respond to evolving neurological injury before it becomes irreversible. This review article comprehensively examines the principal electrophysiological modalities employed in contemporary neuroanaesthetic practice, including electroencephalography (EEG), somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), auditory brainstem responses (ABR), electromyography (EMG), and electrocorticography (ECoG).

A critical focus is placed on the bidirectional relationship between anaesthetic agents and electrophysiological signals. Each modality responds differently to volatile anaesthetics, intravenous hypnotics, opioids, sedatives, and neuromuscular blocking agents, and these interactions fundamentally govern anaesthetic strategy in monitored cases. The physiological variables of temperature, blood pressure, and carbon dioxide tension that additionally confound signal interpretation are analyzed. Validated alert criteria, standardized communication protocols, and the expanding evidence base for IOM-guided outcomes in supratentorial, infratentorial, spinal cord, and epilepsy surgeries are reviewed. Emerging technologies, including high-density EEG, machine learning-assisted signal analysis, and closed-loop anaesthetic delivery, are discussed. Practical recommendations for the neuroanaesthetist, including protocol selection, TIVA regimen design, and team communication frameworks, are provided. Robust evidence demonstrates that multimodality IOM reduces the incidence of permanent neurological deficits and improves surgical decision-making, affirming its role as a standard of care in high-risk cranial and spinal neurosurgery.
Keywords intraoperative neurophysiological monitoring; IOM; electroencephalography; somatosensory evoked potentials; motor evoked potentials; auditory brainstem response; electromyography; electrocorticography; total intravenous anaesthesia; neurosurgery
Field Medical / Pharmacy
Published In Volume 8, Issue 3, May-June 2026
Published On 2026-05-14
DOI https://doi.org/10.36948/ijfmr.2026.v08i03.78474
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