Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: A prospective, multicenter study

作者：Eimear Phelan, Rick Schneider, Kerstin Lorenz, Henning Dralle, Dipti Kamani, André S. Potenza, Niranjan Sritharan, Jenifer Shin, Gregory William Randolph · 发表于：The Laryngoscope · 年份：2013 · DOI：10.1002/lary.24550 · 被引用次数：197 · 研究领域：Thyroid and Parathyroid Surgery、Voice and Speech Disorders、Airway Management and Intubation Techniques

OBJECTIVES/HYPOTHESIS: Existing intraoperative neuromonitoring (IONM) formats stimulate the recurrent laryngeal nerve (RLN) intermittently, exposing it to risk for injury in between stimulations. We report electrophysiologic parameters of continuous vagal monitoring, utilizing a novel real-time IONM format, and relate these parameters to intraoperative surgical maneuvers that delineate nascent adverse but reversible electrophysiologic parameters to prevent nerve injury. These results are correlated with postoperative vocal cord functional outcome. STUDY DESIGN: Prospective multicenter tertiary study. METHOD: Evoked vagal nerve waveform amplitude and latency changes during 102 thyroidectomies were recorded. Adverse electrophysiologic response was categorized into 1-concordant amplitude reduction and latency increase events (combined events) and 2-loss of signal (LOS). Surgical maneuvers were modified when adverse electrophysiologic findings were noted. All patients underwent preoperative and postoperative laryngoscopy; intraoperative electrophysiologic findings were correlated with postoperative laryngeal function. RESULTS: Continuous vagal monitoring did not result in stimulation-evoked nerve injury or intraoperative adverse cardiac, pulmonary, or gastrointestinal effects. Both intraoperative combined events and LOS were associated with development of vocal cord paralysis (VCP) (P = 0.001 and P >0.001 respectively). Combined events had a positive predictive value (PPV) of 33%...