Method of anaesthesia in thyroid surgery with intraoperative monitoring of the recurrent laryngeal nerves

• Published in: Folia medica (Plovdiv) Vol. 43; no. 4; p. 14
• Main Authors: Stefanov, C S, Dimov, R S, Doikov, I Y, Konsulov, S S
• Format: Journal Article
• Language: English
• Published: Bulgaria 2001
• Subjects: Adolescent; Adult; Aged; Anesthesia, Inhalation; Anesthetics, Inhalation; Cranial Nerve Injuries - etiology; Cranial Nerve Injuries - prevention & control; Electric Stimulation; Electrophysiology - methods; Female; Humans; Intraoperative Complications - prevention & control; Male; Middle Aged; Monitoring, Intraoperative - methods; Neuromuscular Nondepolarizing Agents; Recurrent Laryngeal Nerve - anatomy & histology; Recurrent Laryngeal Nerve - physiology; Recurrent Laryngeal Nerve Injuries; Thyroidectomy - adverse effects; Thyroidectomy - methods; Ulnar Nerve - physiology
• ISSN: 0204-8043

The incidence of injury of the recurrent laryngeal nerve (RLN) in various types of surgery is reported to be as high as 12%. By monitoring the recurrent laryngeal nerve intraoperatively we can identify it and preserve it even in atypical positions or in operations for processes involving the nerve. These types of surgery give rise to some specific problems facing the anaesthesiologist and the method of anaesthesia used.
The aim of the study was to assess the efficacy and relevance of an anesthetic method in thyroid surgery with intraoperative monitoring of the RLN. Tasks: 1. To determine the level of myorelaxation in anaesthetic patients by intraoperative neurostimulation of the ulnar nerve. 2. By careful dosing of the non-depolarizing myorelaxants to create a "window" in the myorelaxation immediately before identification of the RLN that is detected by a neurostimulator.
Forty eight patients subjected to different types of thyroid surgery were given inhalational anaesthesia with supplementation of non-depolarizing myorelaxants. The level of relaxation was constantly monitored by neurostimulation of the left ulnar nerve. This peripheral stimulation allows creating a "window" in the myorelaxation just before the identification of the recurrent laryngeal nerve.
There were no perioperative complications in all patients as to both surgery and anesthesia; postoperative comfort was achieved. The recurrent laryngeal nerve was readily identified and its function was preserved in the postoperative period.
The authors consider as a method of choice the general inhalational anaesthesia supplemented with non-depolarizing myorelaxants and permanent intraoperative monitoring of the level of relaxation in surgery with intraoperative monitoring of the cranial nerve and recurrent laryngeal nerve.