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Anesthetic Considerations of Intraoperative Neuromonitoring in Thyroidectomy
- Source :
- Journal of Nippon Medical School = Nippon Ika Daigaku zasshi. 86(5)
- Publication Year :
- 2019
-
Abstract
- Background Intraoperative neuromonitoring (IONM) might reduce the incidence of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy. Although dislocation of endotracheal tube surface electrodes can lead to false-positive IONM results (loss of signal), the risk factors for dislocation and the effects of muscle relaxants are unclear. Therefore, to identify factors that affect IONM results, we examined the frequency and risk factors for tube dislocation after cervical extension before surgery, the effect of sugammadex administration, and the correlation between IONM results and postoperative RLN palsy. Methods Thirty-nine patients scheduled for thyroidectomy from October 2016 to April 2017 were enrolled. All patients underwent standard IONM and pre- and postoperative laryngoscopy. Differences in patient characteristics in the tube dislocation group and non-dislocation group, and differences in amplitude during vagal stimulation before and after sugammadex administration, were assessed by the Mann-Whitney test or Fisher's exact test. Results Tube dislocation occurred in 27 patients (69%). Sterno-cricoid distance was significantly shorter in the dislocation group (n=27) than in the non-dislocation group (n=12) (43.88 [32.2-55.91] mm vs 49.46 [40.66-55.91] mm, respectively; p=0.048). Without sugammadex, amplitude during vagal stimulation was sufficient for monitoring. Nine patients had new-onset RLN palsy, which was transient in all patients. The sensitivity of IONM was 100%, the positive predictive value was 60%, and the negative predictive value was 100%. Conclusions The present findings suggest that anesthesiologists should use video laryngoscopy to correct tube dislocation and that a rocuronium dose of 0.6 mg/kg, without sugammadex, is adequate for IONM.
- Subjects :
- Adult
Male
Intraoperative Neurophysiological Monitoring
medicine.medical_treatment
Laryngoscopy
Sugammadex
Sevoflurane
03 medical and health sciences
0302 clinical medicine
Recurrent laryngeal nerve
Intubation, Intratracheal
Medicine
Humans
Rocuronium
Aged
Anesthetics
Palsy
medicine.diagnostic_test
business.industry
Thyroidectomy
General Medicine
Middle Aged
Exact test
030220 oncology & carcinogenesis
Anesthesia
030211 gastroenterology & hepatology
Female
business
Vocal Cord Paralysis
medicine.drug
Subjects
Details
- ISSN :
- 13473409
- Volume :
- 86
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
- Accession number :
- edsair.doi.dedup.....5c66b025f2bf97cf18ad5db28cb710ec