Anesthetic Considerations for Neuromonitoring During Thyroidectomy

Authors

  • Sirijunya Junyatham Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Alisa Amornkornkijkul Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Nisa Noocharoen Division of Operating Nursing, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Nakhon Pathom 73170, Thailand
  • Anongnat Wuttiprom Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • Phongthara Vichitvejpaisal Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

Keywords:

anesthetic management, neuro- monitoring, recurrent laryngeal nerves, thyroidectomy

Abstract

Neuromonitoring has revolutionized thyroidectomy procedures by providing real-time assessment of nerve function, particularly the recurrent laryngeal nerves. This article explores the multifaceted role of anesthesia practitioners in optimizing neuromonitoring outcomes. It addresses preoperative patient assessment, collaborative communication, and the meticulous selection of anesthetic agents and techniques that influence neuromonitoring accuracy. Future directions encompass emerging technologies, advanced electrophysiological techniques, and individualized anesthetic approaches.

References

Dumitrescu A. Year in thyroidology: basic science. Thyroid. 2023;33:16-20.

Knight J, Andrade M, Weston ZB. Endocrine system 3: thyroid and parathyroid glands. Nursing Times. 2021;117:46-50.

Noussios G, Chatzis I, Konstantinidis S, et al. The anatomical relationship of inferior thyroid artery and recurrent laryngeal nerve: a review of the literature and its clinical importance. J Clin Med Res. 2020;12:640-6.

Bai B, Chen W. Protective effects of intraoperative nerve monitoring (IONM) for recurrent laryngeal nerve injury in thyroidectomy: meta-analysis. Sci Rep. 2018;8:61-70.

Elders BBLJ, Hakkesteegt MM, Ciet P, Tiddens HAWM, Wielopolski P, Pullens B. Structure and function of the vocal cords after airway reconstruction on magnetic resonance imaging. Laryngoscope. 2021;131:E2402-8.

Lin HS, Terrisc DJ. An update on the status of nerve monitoring for thyroid/parathyroid surgery. Curr Opin Oncol. 2017;29:14-9.

Busaidy NL. The year in medical thyroidology review: current challenges and future directions. Thyroid. 2020;30:13-9.

Potenza AS, Araujo Filho VJF, Cernea CR. Injury of the external branch of the superior laryngeal nerve in thyroid surgery. Gland Surg. 2017;6:552-62.

Choi SY, Son YI. Intraoperative neuromonitoring for thyroid surgery: the proven benefits and limitations. Clin Exp Otorhinolaryngol. 2019;12:335-6.

Liddy W, Wu CW, Dionigi G, et al. Varied recurrent laryngeal nerve course is associated with increased risk of nerve dysfunction during thyroidectomy: results of the surgical anatomy of the recurrent laryngeal nerve in thyroid surgery study, an international multicenter prospective anatomic and electrophysiologic study of 1000 monitored nerves at risk from the international neural monitoring study group. Thyroid. 2021;31:1730-40.

Liu XL, Wu CW, Zhao YS, et al. Exclusive real-time monitoring during recurrent laryngeal nerve dissection in conventional monitored thyroidectomy. Kaohsiung J Med Sci. 2016;32:135-41.

Schneider R, Machens A, Sekulla C, Lorenz K, Elwerr M, Dralle H. Superiority of continuous over intermittent intraoperative nerve monitoring in preventing vocal cord palsy. Br J Surg. 2021;10:566-73.

Lian T, Leong D, Ng K, Bajenov S, Sywak M. A prospective study of electromyographic amplitude changes during intraoperative neural monitoring for open thyroidectomy. World J Surg. 2023;47:1971-7.

Lee HS, Oh J, Kim SW, et al. Intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy with adhesive skin electrodes. World J Surg. 2020;44:148-54.

Dhillon VK, Tufano RP. The pros and cons to real-time nerve monitoring during recurrent laryngeal nerve dissection: an analysis of the data from a series of thyroidectomy patients. Gland Surg. 2017;6:608-10.

Kim HY, Tufano RP, Chai YJ, et al. Intraoperative neural monitoring in thyroid surgery: role and responsibility of surgeon. J Endocr Surg. 2018;18:49-60.

Schneider R, Machens A, Lorenz K, Dralle H. Intraoperative nerve monitoring in thyroid surgery-shifting current paradigm. Gland Surg. 2020;9:120-8.

Tewari A, Francis L, Samy RN, et al. Intraoperative neurophysiological monitoring team’s communiqué with anesthesia professionals. J Anaesthesiol Clin Pharmacol. 2018;34:84-93.

Namizato D, MIwasaki M, Ishikawa M, et al. Anesthetic considerations of intraoperative neuromonitoring in thyroidectomy. J Nippon Med Sch. 2019;86:263-8.

Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane systematic review. Br J Anaesth. 2017;119:369-83.

Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia. 2017;72:16-37.

Chang PY, Wu CW, Chen HY, et al. Influence of intravenous anesthetics on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci. 2014;30:499-503.

Li X, Zhang B, Yu L, Yang J, Tan H. Influence of sevoflurane-based anesthesia versus total intravenous anesthesia on intraoperative neuromonitoring during thyroidectomy. Otolaryngol Head Neck Surg. 2020;162:853-9.

Lu IC, Wu SH, Wu CH. Neuromuscular blockade management for intraoperative neural monitoring. Kaohsiung J Med Sci. 2020;36:230-5.

Sung ES, Lee JC, Kim SH, et al. Development of an attachable endoscopic nerve stimulator for intraoperative neuromonitoring during endoscopic or robotic thyroidectomy. Otolaryngol Head Neck Surg. 2018;158:465-8.

Dobnig H, Amrein K. Monopolar radiofrequency ablation of thyroid nodules: a prospective Austrian single-center study. Thyroid. 2018;28:472-80.

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Published

2025-01-07

How to Cite

Junyatham, S., Amornkornkijkul, A., Noocharoen, N., Wuttiprom, A., & Vichitvejpaisal, P. (2025). Anesthetic Considerations for Neuromonitoring During Thyroidectomy. Thai Journal of Anesthesiology, 51(1), 35–40. retrieved from https://he02.tci-thaijo.org/index.php/anesthai/article/view/273056

Issue

Vol. 51 No. 1 (2025): January-February

Section

Review articles

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