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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
Author(s) -
Macias Alvaro A.,
Eappen Sunil,
Malikin Ilya,
Goldfarb Jeremy,
Kujawa Sharon,
Konowitz Paul M.,
Kamani Dipti,
Randolph Gregory W.
Publication year - 2016
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24468
Subject(s) - medicine , otorhinolaryngology , protocol (science) , pacu , recurrent laryngeal nerve , anesthesiology , anesthesia , surgery , endotracheal tube , head and neck surgery , anesthetic , intubation , thyroid , alternative medicine , pathology
Abstract 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