RESUMO
BACKGROUND: Recurrent laryngeal nerve (RLN) monitoring systems should be reliable and safe. Monitoring via electromyographical systems on an endotracheal tube (ETT) is widely spread. The MagStim™ system consists of an adhesive electrode to be fixed on an endotracheal tube. The Xomed™ endotracheal tube provides integrated electrodes. Reliability and side effects had never been compared. As both systems have very different morphological properties, we hypothesized that there might be differences in reliability and the incidence of side effects. METHODS: In a retrospective quality management analysis of 118 patients (MagStim™ electrode, 57 patients; Xomed™ ETT, 61 patients), we compared laryngeal side effects according to the Chilla score and detection rate of the RLN. RESULTS: Both systems had comparable detection rates of the RLN above 95%. Both electrode systems seemed to have similar reliability. Difficulties to detect the nerve were observed in seven patients (four with MagStim, three with Xomed). In the group with the Xomed™ ETT, significantly less mild laryngeal side effects were observed. CONCLUSION: Both MagStim™ and Xomed™ ETT were reliable in detecting the RLN. The Xomed™ ETT, however, might cause milder laryngeal side effects compared with the MagStim™ electrode.
Assuntos
Eletromiografia/instrumentação , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Monitorização Intraoperatória/instrumentação , Nervo Laríngeo Recorrente/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Coortes , Eletromiografia/métodos , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The avoidance of neuromuscular blocking agents (NMBA) for endotracheal intubation is associated with a higher incidence of laryngeal discomfort and lesions, but could impair effectiveness of intra operative recurrent laryngeal nerve monitoring (IONM). METHODS: In a retrospective quality assessment study over a period of 30 months, a collective that had been intubated without NMBA was compared with a group, which had received NMBA. Endolaryngeal EMG was accomplished with a MagStim(®)-EMG-electrode. RESULTS: Out of the 127 patients with 224 nerves at risk (NAR; NMBA 102 NAR, no NMBA 122 NAR), more than 90% received a total intravenous anaesthesia with propofol, and 88% had remifentanil. Laryngeal side effects and damage scores did not differ significantly. CONCLUSIONS: In this special setting of IONM and thyroid surgery, avoidance of NMBA for endotracheal intubation seems not to increase the incidence of laryngeal side effects and lesions. If endotracheal intubation without NMBA is required, the authors suggest a standardized approach using induction agents as propofol and remifentanil.