Relaxierung und elektromyographische Identifikation des N. laryngeus recurrens

Intraoperative neuromonitoring (IONM) has yielded an increasing effect on thyroid surgery. During IONM, the recurrent laryngeal nerve is stimulated electrically and an acoustically transformed electromyographic signal is derived via either a needle electrode placed in the vocalis muscle or an electrode adjusted to the intubation tube. The IONM is used for identifying and predicting the function of the recurrent laryngeal nerve. Especially under difficult anatomic conditions, IONM has proven a valuable tool for identification of recurrent laryngeal nerves. This can lead to decreased occurrence of nerve palsy rates, as shown in numerous studies. The reliability of the IONM signal (defined as the correlation between intraoperative signal interpretation and postoperative vocal cord function) is reflected by a specificity as high as 98.2%, as shown by German multicenter studies. Thus, normal vocal cord function could be demonstrated postoperatively in over 98.2% of patients with intraoperatively unchanged neuromonitoring signals. If the neuromonitoring signal changed during operation, 39% of the patients suffered from transient vocal cord immobility and 12% had permanent loss of vocal cord function.

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Zuverl�ssigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddr�senchirurgie

Timmermann

Hamelmann

Thomusch

et al. 2004

Chirurg

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Electromyographic response persists after peripheral transection: endorsement of current concepts in recurrent laryngeal nerve monitoring in a porcine model

Birkholz

Irouschek

Labahn

et al. 2009

Langenbecks Arch Surg

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This result demonstrated a remarkable pitfall for the neuromuscular monitoring at the recurrent laryngeal nerve: In the human surgical setting, this might have resulted in the false assumption of an anatomical intact nerve. The persistence of distal electromyographic conduction strengthens the proposal to stimulate the vagal nerve as the proximal portion of the nerve as a part of a systematic protocol.

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Failed Vocalis Muscle Monitoring During Thyroid Surgery Resulting From Residual Muscle Relaxation

Ruebsam

Hoenemann²

2017

A & A Case Reports

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Postoperative paralysis of the vocal cords resulting from intraoperative surgical injury of the recurrent laryngeal nerve is one of the most serious complications of elective thyroid surgery. The chance of injury is reduced by using intraoperative neuromonitoring (IONM). This educational report describes a case of IONM failure resulting from residual muscle relaxation that was restored by administration of sugammadex. It discusses possible pharmacology explanations and provides recommendations for how to prevent this situation in daily practice.

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Relaxierung und elektromyographische Identifikation des N. laryngeus recurrens

Cited by 3 publications

References 16 publications

Zuverl�ssigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddr�senchirurgie

Zuverl�ssigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddr�senchirurgie

Electromyographic response persists after peripheral transection: endorsement of current concepts in recurrent laryngeal nerve monitoring in a porcine model

Failed Vocalis Muscle Monitoring During Thyroid Surgery Resulting From Residual Muscle Relaxation

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