Eliminating diathermy-induced artifacts during intraoperative monitoring of somatosensory-evoked potentials: A hardware solution

Somatosensory-evoked potentials (SEPs) recorded intraoperatively are often contaminated by artifacts arising from unipolar diathermy. This increases variability in serial SEP recordings and decreases the reliability of SEPs for intraoperative monitoring. Rejection of single sweeps on the basis of a voltage criterion can only partially prevent the inclusion of sweeps containing artifacts. We describe a low-cost hardware system that will halt SEP acquisition automatically before diathermy becomes active. Activation of the diathermy switch will halt SEP acquisition by sending a digital inhibit signal to the evoked potential machine via a fiberoptic cable. A timer delays the activation of the diathermy until the last sweep has been completed. To allow the electroencephalographic amplifiers to recover from any overload condition resulting from the high-voltage/high-frequency input during diathermy, acquisition is resumed only after a user-selectable time interval. The system was evaluated in 50 patients. It effectively interrupted SEP acquisition each time diathermy was used. By eliminating diathermy noise from the averaged waveforms, the system will allow evoked potential monitoring even during periods of intensive use of diathermy.