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D-Wave Stimulation is Anodal or Cathodal?
Anodal around the C or FC line. Can be quadripolar.
D-Wave Intensity
Up to 100V (usually 150-250 V)
D-Wave Pulse Width
50-75 usec, max 500 usec
D-Wave of Pulses
1
D-Wave ISI
N/A because one train
D-Wave Frequency
1 Hz
D-Wave decreases 30-50% and TceMEPs are stable
No deficit
D-Waves decreases 30-50% but MEPs are lost
transient deficit
If D-Wave is decrease by more than 50% and MEPs are lost
permanent deficit
What should an NP do if their D-Waves attenuate
Any decrease in D-Wave should be reported and MEPs should be ran
What is the impact of inhalational agents on D-Waves?
They are resistant to inhalational agents
What is the impact of muscle relaxants on D-Waves?
Might be beneficial to D-Wave signals as they will quiet scalp muscle activity
How does TIVA (propofol and a narcotic such as fentanyl) affect D-Waves?
TIVA is the preferred anesthetic regimen, especially when TceMEPs are also being run, this case make sure to ask anesthesiologist for bite block. Boluses will not negatively impact D-Wave signals (not generated in synapses)
What morphology would you expect to see in the D-Waves of a patient with an intramedullary spinal cord tumor?
Desynchronized; this will make running signals too unreliable and thus impossible.
What morphology would you expect to see in the D-Waves of a patient with post radiation myelopathy?
Desynchronized; this will make running signals too unreliable and thus impossible.
Can you run D-Waves when there is extensive dural scar tissue on the cord?
No as you will not be able to place electrodes.
What do you expect to see in regards to D-Waves during a scoliosis correction surgery?
Amplitude changes that do not actually represent significant changes.
What additional modality do you need to run when monitoring a scoliosis correction surgery with D-Waves?
TceMEPs; they will help determine if amplitude changes in the D-Wave are actually significant during cord placement manipulation.
What should the NP offer when both D-Waves and TceMEP amplitudes are attenuated during a scoliosis correction surgery>
Stagnara Wake up test to see if patient is paralyzed.
