What indicates adequate stimulation of the median nerve during IONM?

During intraoperative neuromonitoring (IONM), the presence of consistent and stable responses to stimulation of the median nerve indicates adequate stimulation. When there is no change in responses, it signifies that the nerve is being effectively stimulated. This steady response shows that the neural pathways are intact and that the electrical stimuli are successfully reaching and activating the nerve fibers.

If changes in responses were observed, it might suggest complications such as nerve compression or ischemia due to surgical manipulation. Similarly, the absence of peripheral responses could indicate inadequate stimulation or a failure in the neural pathway, rather than an adequate response. Pain response, while it may have clinical relevance, does not assess the effectiveness of nerve stimulation per se, and is not an indicator of the stimulation's adequacy in the context of IONM. Therefore, the consistency in responses to stimulation, as reflected by no change, is the key indicator of adequate median nerve stimulation during IONM.