AI Article Synopsis

  • - The recurrent laryngeal nerve (RLN) can be injured during neck surgery, leading to serious issues with vocal cord function, but using electromyography (EMG) helps identify the nerve and decrease the risk of damage.
  • - Improper placement of specialized EMG endotracheal tubes (ETTs) can lead to unreliable signals, so a new educational protocol was created to standardize their placement and improve RLN monitoring reliability.
  • - Data from surgeries before and after the protocol showed a significant drop in alerts for ETT malposition, highlighting improved accuracy and a sustained reduction in nerve injury risks through ongoing education for anesthesia staff.

Article Abstract

Recurrent laryngeal nerve (RLN) injury during neck surgery can cause significant morbidity related to vocal cord (VC) dysfunction. VC electromyography (EMG) is used to aid in the identification of the RLN and can reduce the probability of inadvertent surgical injury. Errors in the placement of specialized EMG endotracheal tubes (ETT) can result in unreliable signals, false-negative responses, or no response when stimulating the RLN. We describe a novel educational protocol developed to optimize uniformity in the placement of ETTs to improve the reliability of RLN monitoring. An intraoperative neuromonitoring database was queried for all neck surgeries requiring RLN monitoring. Data points extracted for all cases requiring EMG monitoring for neck procedures. Free running and stimulated EMG were monitored and continuously recorded by a certified technologist. Alerts were compared between 2013-14 and 2015-18 using a two-sample test of proportions. Significant reductions in alerts were demonstrated after protocol implementation (7.5% pre-implementation to 2.1% post). Alerts were compared between 2013-14 (overall alert rate of 1.8%, pre-implementation period) and 2015-18 (overall alert rate of 2.8%, post-implementation period). Protocolization for placement of EMG-ETT improved accuracy in EMG monitoring. In the follow-up cohort of 1,080 patients, use of this protocol continued to reduce the rate of alerts related to ETT malposition, confirming the sustainability of this intervention through routine education. The risk of nerve injury is reduced when the rate of alerts is minimized. Scheduled or continuous protocol education of anesthesia personnel should continue to ensure compliance with protocol.

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Source
http://dx.doi.org/10.1080/21646821.2024.2382489DOI Listing

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