Improving Safety of Neural Monitoring in Thyroid Surgery: Educational Considerations in Learning New Procedure

Dionigi, Gianlorenzo; Bartolo, Vincenzo; Rizzo, Antonio; Marullo, Massimo; Fabiano, V.; Catalfamo, Antonio; Pergolizzi, Francesca Pia; Cancellieri, Antonino; Melita, G

doi:10.16956/jes.2018.18.1.21

Cited by 5 publications

(4 citation statements)

References 37 publications

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“…Correct management and titration of the neuromuscular blockade (NMB) are important in successful neural monitoring 4 . Adequate NMB is necessary for tracheal intubation and muscle relaxation.…”

Section: Introductionmentioning

confidence: 99%

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Lee

Won

et al. 2021

The Kaohsiung J of Med Scie

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Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery to reduce recurrent laryngeal nerve injury. The use of neuromuscular blockade agent to facilitate tracheal intubation, is a common cause of IONM failure. We performed a retrospective analysis to assess the efficacy of neostigmine‐glycopyrrolate as a neuromuscular blockade reversal agent for IONM during thyroid surgery. Rocuronium (0.6 mg/kg) was administered for muscle relaxation. Neostigmine (2 mg) and glycopyrrolate (0.4 mg) were administered immediately after intubation. Cricothyroid muscle‐twitch response upon external branch of superior laryngeal nerve stimulation and electromyography amplitudes of vagal and recurrent laryngeal nerves before (V1, R1) and after thyroid resection (V2, R2) were recorded. Fifty patients (23 males, 27 females) were included in the analysis. The diagnoses comprised 43 papillary thyroid carcinomas and seven benign diseases. The mean time between rocuronium injection and neostigmine‐glycopyrrolate injection was 5.1 ± 1.2 min, and the mean time from neostigmine‐glycopyrrolate injection to successful cricothyroid muscle twitching upon external branch of superior laryngeal nerve stimulation was 21.0 ± 4.5 min. All patients had V1 and R1 amplitudes of more than 500 μV each, with mean V1 and R1 amplitudes of 985.3 ± 471.6 μV and 1177.2 ± 572.7 μV, respectively. Neostigmine‐glycopyrrolate was effectively used as a neuromuscular blockade reversal agent for IONM in thyroid surgeries without a significant increase in bucking events. Administration of neostigmine‐glycopyrrolate immediately after intubation can be recommended for successful NMB reversal to facilitate IONM during thyroid surgery.

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Section: Introductionmentioning

confidence: 99%

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Lee

Won

et al. 2021

The Kaohsiung J of Med Scie

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“…The reported complications of RLN injuries may be related to positioning of electrodes for IONM at the larynx, obstructing the endotracheal tube; the drugs used for anesthesia; and the effects of electrical stimulation at nerve structural and systemic levels [5]. Stretch injury to the RLN is the most common type of RLN injury.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve for Using Intraoperative Neural Monitoring Technology of Thyroid Cancer

Zhao

Bai

Teng

et al. 2019

BioMed Research International

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We investigated the learning curve for using intraoperative neural monitoring technology in thyroid cancer, with a view to reducing recurrent laryngeal nerve injury complications. Radical or combined radical surgery for thyroid cancer was performed in 82 patients with thyroid cancer and 147 recurrent laryngeal nerves were dissected. Intraoperative neural monitoring technology was applied and the “four-step method” used to monitor recurrent laryngeal nerve function. When the intraoperative signal was attenuated by more than 50%, recurrent laryngeal nerve injury was diagnosed, and the point and causes of injury were determined. The time required to identify the recurrent laryngeal nerve was 0.5–2 min and the injury rate was 2.7%; injuries were diagnosed intraoperatively. Injury most commonly occurred at or close to the point of entry of the nerve into the larynx and was caused by stretching, tumor adhesion, heat, and clamping. The groups are divided in chronological order; a learning curve for using intraoperative neural monitoring technology in thyroid cancer surgery was generated based on the time to identify the recurrent laryngeal nerve and the number of cases with nerve injury. The time to identify the recurrent laryngeal nerve and the number of injury cases decreased markedly with increasing patient numbers. There is a clear learning curve in applying intraoperative neural monitoring technology to thyroid cancer surgery; appropriate use of such technology aids in the protection of the recurrent laryngeal nerve.

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“…One of the concerns relating to guidelines in the field of IONM is related to their medicolegal implications (13)(14)(15)(16)(17)(18)(19). Some reports suggest that the courts are applying new clinical practice guidelines in their decision-making processes, it is worthwhile to anecdotally recall a case in which a patient sustained RLN palsy after thyroid surgery, and the plaintiffs' expert supported the view that IONM was considered the standard of care (13)(14)(15)(16)(17)(18)(19).…”

Section: Is It Evidence-based?mentioning

confidence: 99%

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

et al. 2018

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Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus, which must at least be selected on an individual basis. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in centers highly specialized in thyroid surgery.

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Improving Safety of Neural Monitoring in Thyroid Surgery: Educational Considerations in Learning New Procedure

Cited by 5 publications

References 37 publications

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Learning Curve for Using Intraoperative Neural Monitoring Technology of Thyroid Cancer

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

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