Basic principles of anaesthetic care for intraoperative transcranial motor evoked potentials monitoring

Intraoperative evoked potentials monitoring is an essential neurophysiological modality used in surgeries with a risk of CNS functional integrity damage. Transcranial motor evoked potentials (MEPs) are one of the most important modalities. Trained surgeons can effectively monitor MEPs under the supervision of a neurophysiologist. Effective cooperation among all operating team members, anaesthesiologists, and neurophysiologist is essential for proper neuromonitoring. The aim of this article is to comprehensively summarize all possible factors that can affect the quality of intraoperative MEPs monitoring. The authors focus on the effect of anaesthetic drugs and anaesthetic management, including anaesthesia maintenance or non-pharmacological factors, which can affect the MEPs' reproducibility. This review provides essential information to all members of a perioperative team that take care for patients during surgery with MEPs monitoring. This information can facilitate cooperation and streamline communication across all related disciplines.