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Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk
Author(s) -
Sinclair Catherine F.,
Téllez Maria J.,
Ulkatan Sedat
Publication year - 2018
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.25377
Subject(s) - medicine , recurrent laryngeal nerve , reflex , anesthesia , electromyography , superior laryngeal nerve , adductor muscles , surgery , larynx , anatomy , thyroid , psychiatry
Background Continuous vagal intraoperative neuromonitoring (IONM) currently requires placement of a vagal nerve electrode. Herein, we present data from 100 patients (134 nerves‐at‐risk) monitored continuously during neck endocrine surgeries using a noninvasive, new methodology that solely utilizes endotracheal tube electrodes to simultaneously stimulate laryngeal mucosa and record a laryngeal adductor reflex continuous IONM (LAR‐C‐IONM) response. Methods The laryngeal adductor reflex (LAR) was elicited by electrical laryngeal mucosal stimulation on the side contralateral to the operative field using endotracheal tube electrodes. All patients completed preoperative and postoperative laryngeal and voice examinations. Results One hundred patients (134 nerves‐at‐risk) were included. Significantly more nerves‐at‐risk with an LAR opening to closing amplitude decrement >60% or with absolute closing amplitude <100 μV had postoperative vocal fold paralysis ( P < .001). The LAR‐C‐IONM was highly sensitive to recurrent laryngeal nerve (RLN) stretch or compression. Conclusion The LAR‐C‐IONM is a promising new way to perform continuous vagal monitoring that requires no equipment other than an electromyography (EMG) endotracheal tube and is undergoing further, large‐scale evaluation.