title: Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury.
abstract: BACKGROUND
  Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve (RLN) palsy only after the damage has been done.
  
  
  METHODS
  Fifty-two patients (52 nerves at risk) who underwent continuous intraoperative nerve monitoring (CIONM) for thyroid surgery via vagus nerve stimulation had their electromyographic (EMG) tracings recorded and correlated with surgical maneuvers and postoperative RLN function.
  
  
  RESULTS
  There was 1 imminent loss of signal (LOS) with intraoperative signal recovery and there were 4 losses of signal with corresponding unilateral transient RLN palsy. When EMG amplitude decreased >50% and EMG latency increased >10%, LOS and postoperative RLN palsy were noted in 4 of 8 patients (50%) who had multiple combined events. In 9 of 13 patients (70%) who developed adverse EMG changes, modification of the causative surgical maneuver resulted in recovery of those EMG changes and aversion of impending RLN palsy.
  
  
  CONCLUSIONS
  CIONM reliably signaled impending nerve injury, enabling immediate corrective action.
authors.affiliation: Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Rick
authors.initials: R
authors.lastname: Schneider
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.forename: Carsten
authors.initials: C
authors.lastname: Sekulla
authors.forename: Eimear
authors.initials: E
authors.lastname: Phelan
authors.forename: Phuong Nguyen
authors.initials: PN
authors.lastname: Thanh
authors.forename: Michael
authors.initials: M
authors.lastname: Bucher
authors.forename: Andreas
authors.initials: A
authors.lastname: Machens
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.forename: Kerstin
authors.initials: K
authors.lastname: Lorenz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014630:Vagus Nerve