To stimulate both tibial nerves asynchronously, what must be done?

Stimulating both tibial nerves asynchronously involves timing the stimulation so that there is a deliberate delay between the activations of the two nerve pathways. When you delay the second stimulator, it ensures that the signals from each tibial nerve do not overlap, allowing for a distinct and clear measurement of responses from each nerve separately. This is crucial in neurophysiologic intraoperative monitoring, as it provides better clarity and specificity in evaluating the functional integrity of each nerve pathway during surgical procedures.

Introducing a delay to the second stimulator creates a staggered activation, which aids in distinguishing the responses generated by each nerve, thus allowing for a more accurate assessment of neural function during monitoring. This technique helps in identifying any underlying issues that may not be apparent if the nerves were stimulated simultaneously, leading to overlapping responses that could mask critical data.

Other options, such as introducing a positive or negative trace delay or delaying the first stimulator, do not accomplish the goal of achieving asynchronous stimulation effectively, as they either do not properly stagger the activation of both nerves or may change the nature of the response in a way that is not beneficial for assessment purposes.