Failed Vocalis Muscle Monitoring During Thyroid Surgery Resulting From Residual Muscle Relaxation.
Postoperative paralysis of the vocal cords resulting from intraoperative surgical injury of the recurrent laryngeal nerve is one of the most serious complications of elective thyroid surgery. The chance of injury is reduced by using intraoperative neuromonitoring (IONM). This educational report describes a case of IONM failure resulting from residual muscle relaxation that was restored by administration of sugammadex. It discusses possible pharmacology explanations and provides recommendations for how to prevent this situation in daily practice.
From the *Department of Anesthesiology, Intensive Care and Emergency Medicine, St Marienhospital Vechta, Vechta, Germany; and the †Department of Anesthesiology and Intensive Care, Klinikum Leer gGmbH, Leer, Germany.
Marie-Luise
ML
Ruebsam
Christian
C
Hoenemann
D000732:Androstanols / Q000008:administration & dosage; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D007821:Laryngeal Muscles / Q000187:drug effects* / Q000294:innervation; D008875:Middle Aged; D009126:Muscle Relaxation / Q000187:drug effects*; D019148:Neuromuscular Blockade / Q000379:methods; D012009:Recurrent Laryngeal Nerve / Q000187:drug effects / Q000502:physiology; D000077123:Rocuronium; D000077122:Sugammadex; D013965:Thyroidectomy / Q000379:methods*; D055536:Vagus Nerve Stimulation / Q000379:methods; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control*; D014827:Vocal Cords / Q000187:drug effects* / Q000294:innervation; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000627:therapeutic use*
D000732:Androstanols; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium