[Contribution of neuromonitoring to the safety of tracheal extubation after total thyroidectomy. Prospective study with needle electrodes].
OBJECTIVE
Bilateral laryngeal paralysis cause serious respiratory complications. In thyroid surgery, neuromonitoring helps in identifying the recurrent laryngeal nerve, reports on its functioning at the end of surgery, supports decision making, and may reduce the risk of bilateral paralysis. Our objective was to estimate the influence of neuromonitoring in operative strategy and extubation safety in total thyroidectomy.


METHODS
A non-randomized prospective study was conducted on 210 patients undergoing total thyroidectomy (420 laryngeal nerves stimulated included). We collected qualitative neuromonitoring variables (presence or absence of final signal after stimulation of the vagus nerve), and postoperative indirect laryngoscopy (normal motility or paralysis), performed until 3rd day after the surgery.


RESULTS
The accuracy of the test was 99.5% (95% CI 98.3 to 99.9). The positive predictive value was 100% (95% CI 99.1 to 100), which showed the high ability of neuromonitoring to predict paralysis in case of loss of signal, and the negative predictive value was 99.5% (95% CI 98.3 to 99.9), which indicated its predictive capacity for normal motility when there is a normal signal.


CONCLUSIONS
In our group of patients, recurrent laryngeal nerve monitoring was useful in total thyroidectomy as it provided information on the prognosis of laryngeal motility, and helped in making decisions during surgery when there was signal loss. Due to the risk of serious respiratory complications due to bilateral recurrent laryngeal nerve paralysis, we opted for the performing of the 2-stage total thyroidectomy in case of signal loss in the first lobectomy. Thereby, neuromonitoring contributed to the safety of the airway in tracheal extubation, aiding in the prevention of a possible bilateral laryngeal paralysis.
Servicio de Otorrinolaringología, Complejo Asistencial de Zamora, Zamora, España. Electronic address: jlpardal@saludcastillayleon.es.
J L
JL
Pardal-Refoyo
J J
JJ
Cuello-Azcárate
C
C
Ochoa-Sangrador
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D000465:Algorithms; D004566:Electrodes; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009339:Needles; D011182:Postoperative Care; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D013965:Thyroidectomy
Airway extubation; Extubación; Intra-operative monitoring; Monitorización intraoperatoria; Nervio laríngeo recurrente; Parálisis de cuerda vocal; Patient safety; Recurrent laryngeal nerve; Seguridad del paciente; Thyroidectomy; Tiroidectomía; Vocal cord paralysis