scholarly journals Intraoperative Neuromonitoring During Thyroid Surgery: The Effect of Surgical Positioning

2018 ◽  
Vol 26 (1) ◽  
pp. 77-81
Author(s):  
Jason E. Crowther ◽  
Daniah Bu Ali ◽  
Jeremy Bamford ◽  
San-Wook Kang ◽  
Emad Kandil
Keyword(s):  
Vagus Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Neurological Injury ◽  
Neural Recordings ◽  
Surgical Positioning ◽  
Ultrasound Measurements ◽  
Before And After ◽  
Recurrent Laryngeal Nerves ◽  
Proper Interpretation

Intraoperative neuromonitoring during thyroid surgery has been used to successfully prevent permanent neurological injury by early identification of anatomical variants. Proper interpretation of neuromonitoring data requires knowledge of what factors might affect the data. In this study, we examined the effect of surgical positioning on the latency and amplitude of neural recordings made from the vocalis muscle during thyroid surgery. A retrospective review was performed of 145 patients who underwent thyroid surgery. Eighty-three had open cervical procedures, and 62 had robotic-assisted transaxillary procedures. Intraoperative neuromonitoring recordings were made by stimulation of the vagus and recurrent laryngeal nerves for both groups. Ultrasound measurements were made of a subset of the transaxillary patients immediately before and after arm positioning. Groups differed only on right-sided recordings. Patients with transaxillary surgeries had significantly shorter latencies evoked from the vagus nerve. We found that vagus nerve–evoked latencies were also correlated to ultrasound measurements of the nerves. Surgical positioning during thyroid surgery is a factor that may affect intraoperative neuromonitoring data and should be taken into account by the surgeon during interpretation.

scholarly journals Feasibility of Intraoperative Neuromonitoring during Thyroid Surgery after Administration of Sugammadex for Reversal of Neuromuscular Blockade

2020 ◽  
Author(s):  
shuwen yang ◽  
xi liu ◽  
xiangyuan chen ◽  
changhong miao ◽  
yu wang ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Vagus Nerve ◽  
Thyroid Surgery ◽  
Muscle Relaxation ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
High Dose ◽  
Anesthesia Induction ◽  
Before And After ◽  
Neural Monitoring

Abstract Background Neuromuscular blocking agent (NMB) dosage suggested in current intraoperative neural monitoring (IONM) clinical guideline might cause operational difficulty during thyroid surgery. This study evaluated the feasibility of sugammadex with an enhanced NMB recovery protocol. Methods Complete IONM data for 57 patients who had normal cord mobility were investigated: 32 patients received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at vagus nerve exposure (group S) and 25 received rocuronium 0.3mg/kg with 0.9% NaCl 2mL/kg instead (group R). Electromyography (EMG) signals were obtained from the vagus nerve and RLN before and after resection of the thyroid lobe and were defined as V1, V2 and R1, R2 signals, respectively. The train-of-four ratio (TOFr) was used for continuous quantitative monitoring of neuromuscular transmission. Results Mean EMG in Group S (vagus nerve: 722.728 ± 160.11μV, RLN: 1028.64 ± 180.34μV) was greater than Group R (568.884 ± 135.15, 776.66 ± 145.91μV) from first minute after administration of sugammadex (P <0.05). The time for tracheal intubation was 102.97±64.5 seconds in group S with high dose rocuronium, while 195.12±68.9 seconds in group R (p < .001). Conclusions Rocuronium 0.6 mg/kg can greatly shorten the tracheal intubation time and reduce the difficulty of surgery, and employment sugammadex can reverse residual muscle relaxation of rocuronium and optimize IONM conditions.

scholarly journals Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jongjin Kim ◽  
Hyeon Jong Moon ◽  
Young Jun Chai ◽  
Jung-Man Lee ◽  
Ki-Tae Hwang ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Medical Records ◽  
Electric Stimulation ◽  
Intraoperative Neuromonitoring ◽  
Vagus Nerves ◽  
Nerve Monitoring ◽  
Continuous Feedback ◽  
The Mean ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring

Objective. Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. Methods. Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. Results. Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. Conclusion. The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.

Ultrasound visualization of the vagus nerve for intraoperative neuromonitoring in thyroid surgery

2020 ◽  
Author(s):  
Dana M. Hartl ◽  
Sophie Bidault ◽  
Elizabeth Girard ◽  
Joanne Guerlain ◽  
Ingrid Breuskin ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring

scholarly journals Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes

2021 ◽  
Vol 64 (6) ◽  
pp. 416-421
Author(s):  
Sang Gyu Seo ◽  
Hyoung Shin Lee ◽  
Ki Hun Jo ◽  
Sung Won Kim ◽  
Kang Dae Lee
Keyword(s):  
At Risk ◽  
Vagus Nerve ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Standard Procedure ◽  
Thyroid Cartilage ◽  
Intraoperative Neuromonitoring ◽  
Skin Electrodes ◽  
Clinicopathologic Factors ◽  
The Mean

Background and Objectives Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed.Results IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group.Conclusion IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.

Intraoperative Neuromonitoring of the laryngeal nerves in thyroid surgery

2019 ◽  
Author(s):  
Mikhail O Vozdvizhenskii ◽  
AE Orlov ◽  
AA Makhonin ◽  
VV Stadler ◽  
Ya.S Matyash
Keyword(s):  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerves

INTRAOPERATIVE CONTINUOUS NEUROMONITORING OF LARYNGEAL RECCURENT NERVES IN PATIENTS WITH THYROID CANCER

2019 ◽  
Vol 65 (3) ◽  
pp. 342-348
Author(s):  
Viktor Makarin ◽  
Anna Uspenskaya ◽  
Arseniy Semenov ◽  
Natalya Timofeeva ◽  
Roman Chernikov ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Laryngeal Muscles ◽  
Neural Transmission ◽  
Continuous Neuromonitoring ◽  
Surgical Manipulation

Laryngeal muscles paresis ranks second in prevalence of postoperative complications after thyroid surgery. Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) results in reduction of cases with dysphonia and prevents such severe complication as bilateral paresis. Currently there are two types of monitoring: intermittent and continual. When using intermittent IONM surgeon has no opportunity to control electrophysiology state of RLN during intervals between stimulations. In case of continual IONM date on amplitude and latency are available to surgeon in real time every second, allowing him instantly react to any disturbance of neural transmission to prevent its damage by changing surgical manipulation. This work presents the first experience of using continual neuromonitoring of RLN in Russia, the procedure is described in details its safety. It is represented the possibility of prevention of bilateral laryngeal muscles paresis.

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