Effect of laryngotracheal topical anesthesia on recurrent laryngeal nerve monitoring during thyroid Surgery

A new anesthesia scheme for parathyroidectomy under neuromonitoring: a retrospective cohort study

Background

Parathyroidectomy under nerve monitoring has been carried out for nearly ten years in the China-Japan Union Hospital of Jilin University. We retrospectively evaluated patients' prognosis with secondary hyperparathyroidism (SH) under neuro- and non-neuro-monitored parathyroidectomy anesthesia. The purpose of this study is to summarize and introduce a new anesthesia scheme for parathyroidectomy under nerve monitoring.

Methods

From January 2000 to December 2019, 200 patients with SH in the China-Japan Union Hospital of Jilin University were retrospectively analyzed. Among them, 100 patients underwent parathyroidectomy under neurological monitoring (Group A), and 100 patients underwent parathyroidectomy without neurological monitoring (Group B). The dosage of muscle relaxant, parathyroid hormone (PTH), serum calcium, phosphorus, urea, creatinine, and alkaline phosphatase (ALP) was recorded before surgery (T0), after surgery (T1), at discharge (T2), during skin incision (Ta), at four parathyroidectomies (Tb), and 10 min after total removal. The levels of PTH were measured at four-time points (Tc) and 30 minutes (Td) after complete resection.

Results

After screening and propensity score match (PSM), the data of 92 patients were analyzed. Group A's muscle relaxant dose was significantly less than Group B; the length of hospital stay in Group A was significantly lower than in Group B (P<0.05). The serum calcium levels, phosphorus, urea, and creatinine at T2 in Group A were lower than those in Group B (P<0.05).

Conclusions

Parathyroid nerve monitoring technology combined with preoperative complete anesthesia scheme, anesthesia induction with one time ED95 (95% effective drug dose) cis-atracurium, end breath gas, and sevoflurane maintenance anesthesia under BIS monitoring can improve the prognosis of patients, shorten the length of hospital stay, and is effective and safe.

A mouthful - airway matters in intraoperative neuromonitoring in auditory brainstem implant surgery for the pediatric patient: a case series

BACKGROUND

The Auditory brainstem implant (ABI) is a new surgical option for hearing impaired children. Intraoperative neurophysiology monitoring includes brainstem mapping of cranial nerve (CN) IX, X, XI, XII and their motor nuclei, and corticobulbar tract motor-evoked potential. These require laryngeal electrodes and intra-oral pins, posing a challenge to airway management especially in the pediatric airway, where specialized electromyogram (EMG) tracheal tubes are not available. Challenges include determining the optimum position on the endotracheal tube (ETT) in which to place laryngeal electrode, and the increase in external diameter of ETT contributed by the wrapping the electrode around the shaft of ETT; this may necessitate downsizing of the tracheal tube. An appropriate size ETT minimizes displacement, which in turn can affect electrode contact with the vocal cords. Finally, a small thus crowded pediatric airway makes for difficult visualization during placement of intraoral neuromonitoring electrodes. The use of a videolaryngoscope helps determine optimum electrode placement.

CASE PRESENTATION

We describe intraoperative neurophysiology monitoring and airway management for the first two ABI procedures in Singapore, conducted for children with congenitally absent cochlear nerves.

CONCLUSION

Neurophysiology cranial nerve IX, X, XII monitoring in the ABI procedure requires intraoral placement of electrodes. Care should be exercised during placement and removal. Vagus nerve monitoring in children requires attention to tube preparation, and consideration should be given to avoidance of airway topicalization.