A novel methodology for assessing laryngeal and vagus nerve integrity in patients under general anesthesia

Sinclair, Catherine F.; Téllez, María J.; Tapia, Oscar R.; Ulkatan, Sedat; Deletis, Vedran

doi:10.1016/j.clinph.2017.03.002

Cited by 143 publications

(64 citation statements)

References 15 publications

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“…For detailed methodology of LAR‐CIONM for vagal and RLN motor fibers, please refer to prior publications on this topic . For LAR‐CIONM of sensory nerve fibers, the methodology varies somewhat because the LAR is elicited by ETT electrode stimulation of supraglottic mucosa ipsilateral to the IBSLN at risk and is recorded from the contralatera l vocal fold supplied by RLN motor fibers not at risk running in the contralateral neck.…”

Section: Methodsmentioning

confidence: 99%

“…In 2017, a novel methodology was introduced to continuously monitor vagal and RLN motor fibers using the laryngeal adductor reflex (LAR), termed LAR‐CIONM . The LAR is a brainstem reflex initiated by supraglottic irritation.…”

Section: Introductionmentioning

confidence: 99%

“…Afferent information is carried by the internal branch of the superior laryngeal nerve (IBSLN) to the medulla oblongata, with motor fibers of the vagus nerve (via the RLN) activating laryngeal adductor musculature to initiate vocal fold contraction and airway protection. Previous publications have reported on the utility of this technique for continuously monitoring vagus nerve motor fibers during neck endocrine, cervical spine, and lower brainstem procedures . Due to the anatomical separation of afferent and efferent limbs of the reflex, it was hypothesized that mapping and monitoring of vagus nerve sensory fibers may also be possible using the LAR.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Sinclair¹,

Téllez²,

Roldán³

et al. 2019

The Laryngoscope

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Vagal schwannomas are rare, benign tumors. Intermittent intraoperative neuromonitoring via selective stimulation of splayed motor fibers running on the schwannoma surface to elicit a compound muscle action potential has been previously reported as a method of preserving vagal motor fibers. In this case report, vagal sensory fibers are mapped and continuously monitored intraoperatively during high vagus schwannoma resection using the laryngeal adductor reflex (LAR). Mapping of nerve fibers on the schwannoma surface enabled identification of sensory fibers. Continuous LAR monitoring during schwannoma subcapsular microsurgical dissection enabled sensory (and motor) vagal fibers to be monitored in real time with excellent postoperative functional outcomes. Laryngoscope, 129:E434–E436, 2019

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Sinclair¹,

Téllez²,

Roldán³

et al. 2019

The Laryngoscope

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“…Until recently, the only method of C‐IONM requires placement of a stimulating electrode around the vagus nerve, which can become displaced intraoperatively and requires dissection between the common carotid artery and internal jugular vein . In the first half of 2017, we published a case series of 15 patients whose RLNs were continuously monitored during thyroid and cervical spine surgeries using no equipment other than an EMG endotracheal tube . Herein, we present the first large series of patients (100 patients, 134 nerves‐at‐risk) continuously monitored during neck endocrine procedures using the laryngeal adductor reflex (LAR‐C‐IONM), in addition to conventional I‐IONM.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 In the first half of 2017, we published a case series of 15 patients whose RLNs were continuously monitored during thyroid and cervical spine surgeries using no equipment other than an EMG endotracheal tube. 12 Herein, we present the first large series of patients (100 patients, 134 nerves-at-risk) continuously monitored during neck endocrine procedures using the laryngeal adductor reflex (LAR-C-IONM), in addition to conventional I-IONM. This comprehensive new methodology solely utilizes endotracheal tube electrodes to simultaneously stimulate the laryngeal mucosa and record a laryngeal adductor reflex (LAR).…”

Section: Introductionmentioning

confidence: 99%

Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk

Sinclair¹,

Téllez

Ulkatan

2018

Head & Neck

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BIS‐guided deep anesthesia decreases short‐term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery

et al. 2019

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Objectives Postoperative cognitive dysfunction (POCD) is a common clinical complication, with an underlying pathophysiology linked to heightened levels of neuroinflammation. However, it requires clarification as to whether the depth of anesthesia modulates postoperative cognitive dysfunction. This study investigated the association between depth of anesthesia and POCD in elderly patients undergoing abdominal surgery. Methods A total of 120 patients aged 60 years or older who were planned for abdominal surgery under total intravenous anesthesia were included in this study. The depth of anesthesia was guided by monitoring Bispectral Index (BIS) data. All study participants completed a battery of nine neuropsychological tests before surgery and at 7 days and 3 months after surgery. POCD was calculated by using the reliable change index. Plasma concentration of C‐reactive protein (CRP), interleukin (IL)‐1β, IL‐10, S‐100β, and norepinephrine (NE) were measured. Results The incidence of POCD at 7 days after surgery in the deep anesthesia group was 19.2% (10/52), which was significantly lower (p = 0.032) than the light anesthesia group 39.6% (21/53). The depth of anesthesia had no effect on POCD at 3 months after surgery (10.3% vs 14.6%, respectively, p = 0.558). Similarly, plasma levels of CRP and IL‐1β in deep anesthesia group were lower than that in light anesthesia group at 7 days after surgery (p < 0.05), but not at 3 months after surgery (p > 0.05). There were no significant differences in the plasma concentration of IL‐10, S‐100β, and NE between the groups (p > 0.05). Conclusions Deep anesthesia under total intravenous anesthesia could decrease the occurrence of short‐term POCD and inhibit postoperative peripheral inflammation in elderly patients undergoing abdominal surgery, compared with light anesthesia.

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A novel methodology for assessing laryngeal and vagus nerve integrity in patients under general anesthesia

Cited by 143 publications

References 15 publications

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk

BIS‐guided deep anesthesia decreases short‐term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery

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