title: Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases.
abstract: Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.
  
  
  
  The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period.
  
  
  
  No complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors.
  
  
  
  An IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1494, 2016.
authors.affiliation: Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Macias
authors.affiliation: Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sunil
authors.initials: S
authors.lastname: Eappen
authors.affiliation: Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ilya
authors.initials: I
authors.lastname: Malikin
authors.affiliation: Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Goldfarb
authors.affiliation: Department of Audiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kujawa
authors.affiliation: Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Konowitz
authors.affiliation: Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.affiliation: Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Gregory_Randolph@meei.harvard.edu.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
mesh_terms: D000465:Algorithms; D000776:Anesthesiology / Q000379:methods*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D037981:Neck Dissection; D010280:Parathyroid Glands / Q000601:surgery; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control; D013965:Thyroidectomy
keywords: anesthesia; intraoperative nerve monitoring (IONM); neuromuscular agents; recurrent laryngeal nerve; thyroid