Interference between muscle relaxation and facial nerve monitoring during parotidectomy

Thiede, Oliver; Klüsener, Thorsten; Sielenkämper, Andreas W.; Aken, Hugo Van; Stoll, Wolfgang; Schmäl, Frank

doi:10.1080/00016480500395146

Cited by 14 publications

(9 citation statements)

References 19 publications

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“…For electrophysiologic monitoring of the facial nerve, neuromuscular blockade should be avoided. 18 Needle electrodes are placed in optimal locations to record activity from the facial muscles, typically in the 4 areas innervated by the facial nerve: frontal, zygomatic, buccal, and marginal mandibular. 19 Ground and stimulator anode electrodes are also placed.…”

Section: Goals Of Facial Nerve Monitoringmentioning

confidence: 99%

Electrophysiologic facial nerve monitoring during parotidectomy

2009

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Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist with the functional preservation of the facial nerve. This review describes the goals, applications, technique, and benefits of electrophysiologic facial nerve monitoring during parotid surgery. A review and analysis of the relevant medical literature related to electrophysiologic facial nerve monitoring during parotid surgery are included.

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Section: Goals Of Facial Nerve Monitoringmentioning

confidence: 99%

Electrophysiologic facial nerve monitoring during parotidectomy

2009

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“…The goals of FNM during parotidectomy include early facial nerve identification, warning to the surgeon of unexpected facial nerve stimulation, mapping of the course of the nerve, reduction of mechanical trauma to the nerve, and evaluation and prognosis of nerve function at the conclusion of the procedure [4,6]. Anesthesia avoidance of NMB has been proposed for FNM [4,8], but it might not ensure tracheal intubation with reduced airway trauma and immobility for surgical exposure [15–17]. In the sugammadex group, twitch % recovered from 0 to >0.9 within 10 min after administration of sugammadex 2 mg/kg at the time point of skin incision (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…However, the value of the FNM may be limited by the administration of neuromuscular blocking agents (NMBAs) relaxants which, on the one hand, are required to prevent laryngeal and/or tracheal damage during endotracheal intubation in cases of general anesthesia, but on the other hand disturb neuromuscular transmission and thus lead to false negative results during facial nerve monitoring [7]. Therefore, anesthesia avoidance of neuromuscular blockade (NMB) has been proposed for FNM [4,8].…”

Section: Introductionmentioning

confidence: 99%

The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

Chang

et al. 2017

The Kaohsiung J of Med Scie

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The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery. Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery.

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“…As muscle relaxants interfere with neuromuscular monitoring,[3] the common practice of general anesthesia (GA) with endotracheal intubation and controlled ventilation with muscle relaxants may not be applicable in patients scheduled for total parotidectomy. Hence, long acting muscle relaxants are generally avoided and intraoperative propofol infusion is administered to ensure patient immobility.…”

Section: Introductionmentioning

confidence: 99%

Transtracheal lidocaine: An alternative to intraoperative propofol infusion when muscle relaxants are not used

Rajan

Puthenveettil

Paul

2014

J Anaesthesiol Clin Pharmacol

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Background:Facial nerve monitoring, often required during total parotidectomy, precludes use of long acting muscle relaxants and propofol infusion is used solely to ensure patient immobility. We aimed to compare intraoperative patient immobility, hemodynamic stability and propofol consumption during total parotidectomy following a transtracheal block.Material and Methods:Forty patients were allocated to 2 equal groups. Preoperatively, group A patients received transtracheal block with 4 ml of 4% lidocaine, while no block was given to patients in group B. If there was patient movement, tachycardia or hypertension, group A patients received a bolus of propofol 30 mg and propofol infusion was started (100mg/hr). In group B, propofol infusion was started (100mg/hr) soon after intubation.Result:Both group A and B were comparable with respect to patient immobility and hemodynamic stability. There was no intraoperative propofol requirement in group A.Conclusion:Transtracheal block is a safe and successful alternative to propofol infusion during surgeries where muscle relaxants are to be avoided.

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Interference between muscle relaxation and facial nerve monitoring during parotidectomy

Cited by 14 publications

References 19 publications

Electrophysiologic facial nerve monitoring during parotidectomy

Electrophysiologic facial nerve monitoring during parotidectomy

The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

Transtracheal lidocaine: An alternative to intraoperative propofol infusion when muscle relaxants are not used

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