Recurrent Laryngeal Nerve Monitoring in Pediatric Surgery Using a Modified Dragonfly Electrode

Lawlor, Claire M.; Zendejas, Benjamin; Julian, Carlos Munoz-San; Meisner, Jay; Jennings, Russell W.; Choi, Sukgi S.

doi:10.1002/lary.29505

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…Successful modification of the Dragonfly double-channel adhesive electrode to accommodate an ETT as small as 3.0 mm ID (term neonate) and to allow for individual RLN monitoring has been previously published and this modification was used in this series. 14 Disadvantages of the Neurovision Dragonfly adhesive electrode ETTs are similar to those for the NIM ETT with the addition of potential adhesive electrode slippage in the setting of long cases and airway secretions.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery

et al. 2021

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Objectives/Hypothesis: The recurrent laryngeal nerve (RLN) is at risk during pediatric cervical, thoracic, and cardiac surgery. We aim to determine the feasibility and effectiveness of RLN monitoring techniques in all pediatric patients.Study Design: Retrospective case series. Methods: Retrospective review of patients/procedures with RLN(s) at risk and RLN monitoring at Boston Children's Hospital July 2019-October 2020. Primary outcomes: pre/postoperative vocal fold mobility by awake flexible fiberoptic laryngoscopy (FFL). Results: One hundred one patients (median [interquartile range, IQR] age 14.6 months [4.6-49.7 months], weight 10 kg [5.2-16.2 kg]) underwent 122 procedures with RLN(s) at risk. RLN monitoring attempted 111 cases, successful 96 (84%). Surgical indications: esophageal atresia/tracheoesophageal fistula, and tracheobronchomalacia. Sixty-two (56%) procedures in reoperative field. Median follow-up 112 days (IQR 41-230). Pre/postoperative FFL performed 84 procedures (69%), 19 new postoperative RLN injuries (16%), median age 12 months, reoperative fields 11 (18%). Prass probes: 34 cases (28 successful, 82%), 6 injuries (18%), age 12.2 (5.8-23.6) months. Dragonfly electrodes: 45 cases (37 successful, 82%), 8 injuries (18%), age 7.5 (3.8-19) months. Nerve integrity monitoring (NIM) integrated electrode endotracheal tube: 33 cases (33 successful, 100%), 5 injuries (15%), age 90 (58.8-136.7) months. Automatic periodic stimulation (APS): 16 cases, 13 successful (81%), four injuries (25%), age 7.2 (5.3-20.6) months. NIM RLN monitoring is significantly more successful than Prass, Dragonfly (95%CI À0.3 to 0.02, P = .02; and 95%CI 0.05-0.31, P = .008). Rates of injury are not different between types of RLN monitoring (P = .94), with APS use (P = .47), or with monitoring success (95%CI À0.36 to 0.09, P = .28).Conclusions: RLN monitoring is feasible in pediatric patients of all ages. Although NIM type RLN monitoring success is superior, all forms offer similar rates of nerve protection.

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery

et al. 2021

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“…Strategies to monitor and protect the RLN during at-risk operations exist in the form of intraoperative RLN monitoring (IONM) techniques, and these have been successfully adapted and implemented for children as young as neonates. [34][35][36][37][38][39][40] In our practice and since performing this retrospective review, we now routinely use IONM in all our at-risk surgical procedures and screen all patients for evidence of VFMI before and after each procedure with awake flexible laryngoscopy. Pre-and post-operative vocal fold evaluations also allow the surgeon to monitor his or her own VFMI outcomes.…”

Section: Implications For Practicementioning

confidence: 99%

Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery

et al. 2023

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IntroductionChildren undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for symptomatic patients.ObjectiveIdentify the prevalence of VFMI in screened preoperative patients prior to an at‐risk operation to evaluate the value of screening all patients at‐risk for VFMI, regardless of symptoms.MethodsA single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms.ResultsWe evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at‐risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at‐risk surgery (OR 2.3, 95%CI 1.1, 4.8, p = 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p = 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p = 0.001) were more likely to present with VFMI.ConclusionRoutine screening for VFMI should be considered in all at‐risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at‐risk surgery, presence of tracheostomy, or a surgical feeding tube.Level of EvidenceLevel III Laryngoscope, 2023

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Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States

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Lee

et al. 2023

International Journal of Pediatric Otorhinolaryngology

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Recurrent Laryngeal Nerve Monitoring in Pediatric Surgery Using a Modified Dragonfly Electrode

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Cited by 6 publications

References 5 publications

Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery

Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery

Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery

Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States

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