Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery

Ulmer, Christoph; Friedrich, C.; Kohler, Andrea; Rieber, Fabian; Basar, Tarkan; Deuschle, Michael; Thon, Klaus‐Peter; Lamadé, Wolfram

doi:10.1002/hed.21564

Cited by 48 publications

(47 citation statements)

References 52 publications

(69 reference statements)

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“…Beside two anecdotal reports of local and cardiac complications during CIONM in a very few patients (20,21), there are several clinical data showing no evidence of adversity related to the circular dissection of the a vagal nerve segment or related intrinsically to CIONM (11,15,17,19,(22)(23)(24)(25)(26)(27).…”

Section: Safety Of Continuous Neural Monitoringmentioning

confidence: 99%

“…Furthermore, the 1 mA stimulation current used for CIONM is not believed to engender concomitant or subsequent adverse vagal effect leading to central (headache, numbness), cardiac (arrhythmias, bradycardia), pulmonary (bronchospasm), or gastrointestinal (nausea, vomiting) symptoms (9,11,15,17,26,27,30,31). Studies (22,25) that applied stimulation current up to 5.0 mA for CIONM, observed an increased variability in heart rate, implying autonomic nervous system imbalance. The elicited parasympathetic activation was not associated with a compensatory increase in sympathetic activity and remained subclinical.…”

Section: Safety Of Continuous Neural Monitoringmentioning

confidence: 99%

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Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

et al. 2016

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Section: Safety Of Continuous Neural Monitoringmentioning

confidence: 99%

Section: Safety Of Continuous Neural Monitoringmentioning

confidence: 99%

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

et al. 2016

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“…The surgical maneuvers for the stimulation device placement must be accurate and standardized in order to avoid a potential iatrogenic morbidity on the vagal nerve function. This additional surgical step of the continuous monitored approach may be preoperatively explained to the patient and specified in the consent form . All participants were fully informed and signed a specific consent form in this series.…”

Section: Discussionmentioning

confidence: 99%

Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures

Mangano

Kim

et al. 2015

Head & Neck

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“…In this study, the mean continuous VNM time was 68 minutes, which is a very short duration of VN stimulation, but we cannot exclude the possibility that VN palsy may be induced by continuous VNM. Regarding complete EMG signal loss, the effect of VN fatigue must be considered [18] [19]. However, the lower frequency limit for fatigue of vegetative nerves is more than 10 Hz, while we used 3 Hz for stimulation.…”

Section: Discussionmentioning

confidence: 99%

Continuous Vagus Nerve Monitoring during Carotid Endarterectomy

Tamaki¹,

Kubota²,

Node³

et al. 2017

OJMN

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Backgrounds: Injury to the vagus nerve or one of its branches during carotid endarterectomy can result in vocal fold paralysis but the exact mechanism of injury responsible for vocal fold paralysis after carotid endarterectomy is unclear. Aims: This study was performed to identify potential predictors of vagus nerve injury and obtain feedback by application of intraoperative continuous vagus nerve monitoring. Materials and Methods: Seventy-four patients undergoing carotid endarterectomy were enrolled. A new vagus nerve electrode was designed for less invasive continuous vagus nerve stimulation and monitoring of the vocal fold electromyogram without disturbing the surgical procedure. The device was rectangular (13 mm × 9 mm), with two small round electrodes set on a flexible silicon plate and tube. The electrode was fully implantable during carotid endarterectomy and was positioned at the most distal site of the vagus nerve by suturing to the connective tissue without nerve dissection. All patients underwent laryngoscopy to assess postoperative vocal fold and pharyngeal wall palsy at one week after carotid endarterectomy. Results: Sudden loss of the vocal fold electromyogram was noted in two patients (during plaque removal and during arterial wall suture in one each). In these two patients, incomplete vocal fold and pharyngeal palsy was confirmed by laryngoscopy. The cause of vagus nerve injury may have been traction at the time of distal internal carotid artery manipulation. The vocal fold electromyogram remained normal during the operation in the other 72 patients. However laryngoscopy revealed postoperative vocal fold and pharyngeal palsy in six patients. These findings suggested that delayed vagus nerve injury can occur after carotid endarterectomy. Conclusion: The continuous vagus nerve monitoring may be worthwhile for elucidating the mechanism of vagus nerve injury related to carotid endarterectomy.

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Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery

Abstract: HRV analysis revealed a distinct impact of VNS for CIONM on ANS balance. VNS caused parasympathetic predominance that was not countered by increased sympathetic activity.

Cited by 48 publications

References 52 publications

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology

Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures

Continuous Vagus Nerve Monitoring during Carotid Endarterectomy

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