title: Cardiac arrest with vagal stimulation during intraoperative nerve monitoring.
abstract: BACKGROUND
  Intraoperative neuromonitoring (IONM) is widely used during thyroid surgery. During both intermittent and continuous IONM stimulation of the vagus nerve is performed. This has previously been reported to be safe.
  
  
  METHODS
  We present our findings based on the case reports of 2 patients.
  
  
  RESULTS
  IONM of the recurrent laryngeal nerve (RLN), following the standards of the International Neuromonitoring Study Group, was conducted in 2 patients, one undergoing thyroid surgery and the second parathyroid surgery. In both cases, after dissection and stimulation of the vagus nerve on 1 mAmp, the patients became asystolic. Resuscitation efforts were successful in both patients.
  
  
  CONCLUSIONS
  These 2 cases demonstrate that stimulation of the vagus nerve during IONM can lead to profound cardiac events. Consideration should be given to these potential complications when utilizing IONM. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2419-E2420, 2016.
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden; and Institution for Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden; and Institution for Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Mark
authors.initials: M
authors.lastname: Thier
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden; and Institution for Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Farhad
authors.initials: F
authors.lastname: Salem
keywords: cardiac arrest; intraoperative neuromonitoring (IONM); parathyroid; surgery; thyroid