Influence of Sevoflurane‐Based Anesthesia versus Total Intravenous Anesthesia on Intraoperative Neuromonitoring during Thyroidectomy

Abstract

Objective To examine the influence of sevoflurane-based combined intravenous and inhaled anesthesia versus propofol-based total intravenous anesthesia (TIVA) on intraoperative neuromonitoring (IONM) during thyroidectomy. Study Design A randomized controlled trial. Setting The present study was conducted in a tertiary hospital. Subjects and Methods Forty patients were randomly assigned to a sevoflurane-based combined intravenous and inhalation group (group S) or a propofol-based total intravenous group (group P). Anesthesia was induced with midazolam, sufentanil, propofol, and cisatracurium in both groups and was maintained with sevoflurane and remifentanil in group S and with TIVA with propofol and remifentanil in group P. IONM was performed intermittently according to the IONM formula standard. Results The time until detection of the first positive electromyographic (EMG) signal was significantly longer in group S (median, 41.0 minutes [interquartile range, 37.5-49.3]) than in group P (37.0 minutes [33.3-41.5], P = .028). All patients in group P had a positive EMG signal at initial monitoring, whereas 8 patients (40.0%) in group S did not. The rate of positive EMG signal at initial monitoring was significantly higher in group P than in group S ( P = .006). The amplitude of the evoked potentials at V1, R1, R2, and V2 were similar between the groups. Conclusion Combined intravenous and inhaled anesthesia based on sevoflurane-remifentanil prolonged the time until detection of a positive EMG signal during IONM as compared with TIVA with propofol-remifentanil in patients undergoing thyroidectomy.

Anestesia Geral Durante Tireoidectomias: Monitoramento E Manejo Intraoperatório

“…Após a tireoidectomia total, o paciente precisará de terapia de reposição hormonal para manter os níveis adequados de hormônios tireoidianos no corpo 5,6,8 .…”

“…Existem diferentes tipos de tireoidectomia: tireoidectomia total, que é a remoção completa da glândula tireoide; lobectomia tireoidiana, que é a remoção de um dos lobos da tireoide; tireoidectomia subtotal, que é a remoção de parte da tireoide, deixando uma pequena porção da glândula; e isthmusectomia, que é a remoção do istmo da tireoide, a porção que conecta os dois lobos da glândula 7,8,9 .…”

“…As indicações comuns para tireoidectomia incluem câncer de tireoide, quando há um diagnóstico confirmado ou suspeita de malignidade; bócio multinodular, especialmente se houver sintomas compressivos ou crescimento progressivo; Doença de Graves, em casos onde o tratamento com medicamentos ou radioiodo não é eficaz ou apropriado; e nódulos tireoidianos, quando apresentam crescimento rápido, causam sintomas compressivos ou têm características suspeitas 5,6,8 .…”

Dosage effect of cisatracurium on intubation and intraoperative neuromonitoring during thyroidectomy: a randomized controlled trial

“…The second reason for the difference is the application of TIVA rather than sevoflurane for maintenance of anesthesia in the present study. The enhancement and prolongation of the effect of NMBAs that occurs with inhaled agents were consequently avoided (24)(25)(26). Therefore, we recommend cisatracurium at an optimal dosage of 2× ED 95 (0.1 mg/kg) for intubation of patients undergoing thyroidectomy with IONM.…”

Optimal anesthesia protocols for successful intraoperative neuromonitoring during thyroid surgery

“…In line with this concept, a recent study investigating IONM quality during thyroid surgery reported that time to first satisfactory EMG signal in patients who were administered inhaled anesthetic agent was longer by about 4 minutes compared to those who received TIVA 36) .…”