CNIM ANESTHESIOLOGY AND INTRAOPERATIVE ELECTROPHYSIOLOGICAL
MONITORING 2026/2027 | STUDY GUIDE, PRACTICE QUESTIONS & EXAM
REVIEW
Preoperative Planning - ANS ✔✔Factors such as the airway, positioning, intravenous access,
pathophysiology of the surgical site, fluid management affect anesthesia medication choices for the
procedure and recovery period.
Cerebral Perfusion Pressure - ANS ✔✔Net perfusion of the brain.
Mean arterial pressure (MAP) minus intracranial pressure.
Factors discussed between anesthesia and the surgeon before surgery - ANS ✔✔Positioning, anticipated
blood loss, special procedures, and anticipated procedure risks.
Physician Anesthesiologist - ANS ✔✔Individuals with a medical degree (MD or DO) that have completed
a focused residency in anesthesiology.
CRNA - ANS ✔✔Certified Registered Nurse Anesthetist
Advanced practice nurse with a master's degree who has undergone specific training in anesthesia after
nursing practice.
May work with physician anesthesiologist or as a solo practitioner
Anesthesiology Assistant - ANS ✔✔Master's level education with specific anesthesia training in
classroom and practical course work.
Must always work under the direction of a physician.
Local MAC - ANS ✔✔MAC in this context stands for "monitored anesthesia care"
Describes the use of intravenous medications in patients where local anesthesia is used to anesthetize a
limited region of the body.
Regional Anesthesia - ANS ✔✔Describes the delivery of anesthesia where only part of the body is made
insensitive to the surgical stimulation.
Local anesthesia can be used to anesthetize specific nerves or plexus.
Similar to local MAC, sedation may be such that the patient becomes responsive to stimuli in a
continuum from awake to unresponsive.
Intravenous medications are used to block stimuli and cause amnesia.
IOM is usually not possible with regional block.
, General Anesthesia (GA) - ANS ✔✔Typically used during most procedures where IOM is used.
Several medications are used.
Goals of GA - ANS ✔✔Produce a state of unconsciousness where the patient does not respond to
stimuli.
Make sure patient has no awareness or recall (amnesia) during the procedure.
Used for analgesia and to bock noxious stimuli from activating the nervous system.
Used to block movement (muscle relaxation) of the patient in response to stimuli.
Muscle Relaxation - ANS ✔✔Can be accomplished by blocking transmission at the neuromuscular
junction, but the most common medications used block the reflex transmission of sensory stimuli
through the spinal cord producing peripheral motor activity.
How Anesthetics Work - ANS ✔✔Anesthetic agents act through their interaction with specific synaptic
receptors.
Inhibitory effect of GABA and inhibitory effect of the NMDA receptor, etc.
Drugs differ by respective major synaptic targets and different subunits of the receptors and the
distribution of these receptors throughout the central nervous system.
Phases of Anesthesia - ANS ✔✔Premedication, Induction, Maintenance Phase, Emergence
Premedication - ANS ✔✔The use of medication prior to bring the patient to the procedure room.
Patient may receive midazolam, which contributes to sedation and amnesia.
Patients may also receive an opioid if they are in pain.
Induction - ANS ✔✔After the patient is brought to the procedure room.
Doses are large because of needed initial cortical and brainstem drug effects. Loss of CN-mediated blink
reflex to eyelash stimulation is used to identify adequate brainstem drug effect.
Usually includes a sedative drug like propofol, an opioid, and a muscle relaxant to facilitate intubation.
An "inhalational mask" induction involves the patient breathing sevoflurane with or without nitrous
oxide. An intravenous line is established after induction and sevo can be reduced.
Reduction of agent in the nervous system can take somewhat longer than the decrease of the
concentration in the breaking circuit as shown on the anesthesia monitoring systems.
Maintenance Phase - ANS ✔✔Inhalational and intravenous agents are used for maintenance.
MONITORING 2026/2027 | STUDY GUIDE, PRACTICE QUESTIONS & EXAM
REVIEW
Preoperative Planning - ANS ✔✔Factors such as the airway, positioning, intravenous access,
pathophysiology of the surgical site, fluid management affect anesthesia medication choices for the
procedure and recovery period.
Cerebral Perfusion Pressure - ANS ✔✔Net perfusion of the brain.
Mean arterial pressure (MAP) minus intracranial pressure.
Factors discussed between anesthesia and the surgeon before surgery - ANS ✔✔Positioning, anticipated
blood loss, special procedures, and anticipated procedure risks.
Physician Anesthesiologist - ANS ✔✔Individuals with a medical degree (MD or DO) that have completed
a focused residency in anesthesiology.
CRNA - ANS ✔✔Certified Registered Nurse Anesthetist
Advanced practice nurse with a master's degree who has undergone specific training in anesthesia after
nursing practice.
May work with physician anesthesiologist or as a solo practitioner
Anesthesiology Assistant - ANS ✔✔Master's level education with specific anesthesia training in
classroom and practical course work.
Must always work under the direction of a physician.
Local MAC - ANS ✔✔MAC in this context stands for "monitored anesthesia care"
Describes the use of intravenous medications in patients where local anesthesia is used to anesthetize a
limited region of the body.
Regional Anesthesia - ANS ✔✔Describes the delivery of anesthesia where only part of the body is made
insensitive to the surgical stimulation.
Local anesthesia can be used to anesthetize specific nerves or plexus.
Similar to local MAC, sedation may be such that the patient becomes responsive to stimuli in a
continuum from awake to unresponsive.
Intravenous medications are used to block stimuli and cause amnesia.
IOM is usually not possible with regional block.
, General Anesthesia (GA) - ANS ✔✔Typically used during most procedures where IOM is used.
Several medications are used.
Goals of GA - ANS ✔✔Produce a state of unconsciousness where the patient does not respond to
stimuli.
Make sure patient has no awareness or recall (amnesia) during the procedure.
Used for analgesia and to bock noxious stimuli from activating the nervous system.
Used to block movement (muscle relaxation) of the patient in response to stimuli.
Muscle Relaxation - ANS ✔✔Can be accomplished by blocking transmission at the neuromuscular
junction, but the most common medications used block the reflex transmission of sensory stimuli
through the spinal cord producing peripheral motor activity.
How Anesthetics Work - ANS ✔✔Anesthetic agents act through their interaction with specific synaptic
receptors.
Inhibitory effect of GABA and inhibitory effect of the NMDA receptor, etc.
Drugs differ by respective major synaptic targets and different subunits of the receptors and the
distribution of these receptors throughout the central nervous system.
Phases of Anesthesia - ANS ✔✔Premedication, Induction, Maintenance Phase, Emergence
Premedication - ANS ✔✔The use of medication prior to bring the patient to the procedure room.
Patient may receive midazolam, which contributes to sedation and amnesia.
Patients may also receive an opioid if they are in pain.
Induction - ANS ✔✔After the patient is brought to the procedure room.
Doses are large because of needed initial cortical and brainstem drug effects. Loss of CN-mediated blink
reflex to eyelash stimulation is used to identify adequate brainstem drug effect.
Usually includes a sedative drug like propofol, an opioid, and a muscle relaxant to facilitate intubation.
An "inhalational mask" induction involves the patient breathing sevoflurane with or without nitrous
oxide. An intravenous line is established after induction and sevo can be reduced.
Reduction of agent in the nervous system can take somewhat longer than the decrease of the
concentration in the breaking circuit as shown on the anesthesia monitoring systems.
Maintenance Phase - ANS ✔✔Inhalational and intravenous agents are used for maintenance.
