During a IONM alert (loss of evoked potentials), all of the following are acceptable maneuvers EXCEPT:
a) Discontinuation of volatile anesthetics
b) Hyperventilation
c) Vasopressors to increase MAP to >70 mmHg
d) Packed RBCs to increase Hgb to greater than 10
e) Wake-up test
Answer b. The wake-up test is uncommonly performed in modern operating rooms due to the availability of sensitive neurophysiologic monitoring such as MEP and SSEP signals. However, it is still useful in cases of unclear signals and providers should be familiar with performing the procedure. All of the other answers are accepted parts of the treatment algorithm with the exception of hyperventilation, which will decrease brain and spinal cord perfusion (and potentially alter IONM signals) through vasoconstriction mechanisms.