Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases

Background Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up‐to‐date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anestheti...

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Bibliographic Details
Published in:Head & neck 2016-10, Vol.38 (10), p.1487-1494
Main Authors: Macias, Alvaro A., Eappen, Sunil, Malikin, Ilya, Goldfarb, Jeremy, Kujawa, Sharon, Konowitz, Paul M., Kamani, Dipti, Randolph, Gregory W.
Format: Article
Language:English
Subjects:
Algorithms
anesthesia
Anesthesiology - methods
Humans
intraoperative nerve monitoring (IONM)
Intraoperative Neurophysiological Monitoring - methods
Neck Dissection
neuromuscular agents
Parathyroid Glands - surgery
recurrent laryngeal nerve
Recurrent Laryngeal Nerve - physiology
Recurrent Laryngeal Nerve Injuries - prevention & control
thyroid
Thyroidectomy
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Summary:Background Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up‐to‐date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience. Methods The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16‐year period. Results No complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors. Conclusion An IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck 38: First–1494, 2016
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.24468