natus XLTEK Protektor32, Instructions For Use Manual

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Instructions for Use XLTEK Protektor32
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Using the TcMEP Stimulator with Protektor32
The TcMEP stimulator with Protektor 32 provides a mode of operation that delivers single or train stimuli
at a rate up to a few pulses per second.
Safety Information
Contra-Indications and Exclusions
Contra-indications and exclusion criteria for Protektor32 Transcranial Stimulation mode:
•
Subjects with a history of head injury, stroke, epilepsy, seizures or other neurological impairment.
• Subjects with a history of cerebral aneurysm.
•
Subjects with any type of implanted biomedical device (for example, a pacemaker).
• Subjects with metal plates or fragments in their head.
Protocol for Elicitation of TcMEPs
Place the stimulating electrodes on the patient’s scalp according to your laboratory protocols for
stimulating electrode locations. Several different configurations of stimulating electrodes have been
reported, including stimulation between C3 and C4 [Calancie et al. 1998, 2001; Jones et al. 1996] using
the International 10-20 standards for EEG electrode placement. Next, place recording electrodes
according to the location(s) from which you wish to record.
The ultimate decision of how to use the TcMEP modes (including stimulating electrode placement,
recording electrode placement, and type of electrodes) is up to the user. We refer the user to published,
peer reviewed papers where detailed descriptions of different protocols to perform TcMEP are available.
NOTE: In order to avoid false positive warnings to the surgical team, it is imperative that
there is a thorough understanding that substantive alterations in anesthesia delivery, or
mean arterial blood pressure, can account for deviations from TcMEP intra-operative
baselines.
References:
1) Calancie B., Harris W, Brindle GF, et al: Threshold-level repetitive transcranial electrical
stimulation for intra-operative monitoring of central motor conduction. J. Neurosurg Spine 95:
161-168, 2001.
2) Calancie B., Harris W, Broton JG, Alexeeva N, Green BA: “Threshold-level” multipulse
transcranial electrical stimulation of motor cortex for intra-operative monitoring of spinal motor
tracts: description of method and comparison to somatosensory evoked potential monitoring. J.
Neurosurg 88: 457-470, 1998.
3) Jones SJ, Harrison R, Koh KF, Mendoza N, Crockard HA: Motor evoked potential monitoring
during spinal surgery: responses of distal limb muscles to transcranial cortical stimulation with
pulse trains. Electroencephalogr Clin Neurophysiol 100: 375-383, 1996.