There has been a growth of monitoring in the operating room today. From a “finger on the pulse” as a standard to ECGs and pulse oximeters. Now neurological monitoring in also used extensively in the OR. There are three types of neuro monitoring in the OT which will be discussed today. Firstly, single nerve monitoring, eg the facial nerve during parotid surgery. Next, we have the monitoring of the depth of anaesthesia via the bispectral index and density spectral array. This helps us understand the depth of anaesthesia especially in total intravenous anaesthesia. BIS monitoring is good at indicating an “alert” state, which is why it can reduce the incidence of intraoperative awareness. However, its algorithm does not always accurately predict an “asleep” state. This means an unknown percentage of patients who are already asleep will not be identified because of falsely elevated BIS values. These patients will receive unnecessary dosage of anesthetics resulting in a deep hypnotic state. Given that there may be falsely elevated values, we have to consider when it is best to use the monitors and if it is cost effective. Lastly, we monitor the spinal cord using SSEPs and MEPs during spine surgery especially scoliosis surgery. Today it is standard practice to conduct some form of monitoring when performing any spinal operation that is associated with a high risk of spinal injury. Generally, operations are considered to carry such a risk when corrective forces are applied to the spine, the patient has preexisting neurological damage, the cord is being invaded, or an osteotomy or other procedure is being carried out in immediate juxtaposition to the cord. In this presentation we will look at the latter two monitoring modalities and whether they are needed and are cost effective in the OR.