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우승훈(Seung Hoon Woo) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.2
Over the past decade, the use of intraoperative neuro monitoring (IONM) in thyroid surgery has been widely accepted by surgeons as a useful technique for improving laryngeal neurological identification and speech results, promoting neurophysiological research, educating and training surgeons. Providing patients with information about IONM is a good practice to promote the efficient use of IONM resources and is essential for effective joint decision making between patients and surgeons. The preoperative plan and patient consent process are important for all patients who undergo thyroid surgery. The purpose of this paper is to summarize general and specific considerations, along with pre-consent criteria for using IONM to support surgeons and patients during prethyroid surgery and shared decision making processes.
Optimal anesthesia protocols for successful intraoperative neuromonitoring during thyroid surgery
Jiwon Lee(Jiwon Lee),Jung-Man Lee(Jung-Man Lee),Young Jun Chai(Young Jun Chai) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.2
There are several factors related to anesthesia that are required for successful intraoperative neuromonitoring (IONM) during thyroid and parathyroid surgery, including proper placement of endotracheal tube, adequate neuromuscular blockade, use of appropriate neuromuscular blockade reversal agent, and pain management. In this review, we summarize the anesthesia issues related to IONM during thyroid and parathyroid surgery.
갑상선 수술 중 신경 모니터링의 규범적 근전도 신호 및 해석
이상은(Sangeun Lee),김보해(Bo Hae Kim) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.2
Quantitative analysis of electromyogram (EMG) signals measured during thyroid surgery provides important information about the integrity of the nerve, and it allows to minimize the surgical related complication. Normative data in intraoperative neuromonitoring (IONM) during thyroid surgery provide reasonable evidence for determining setting value of IONM system, clearly predicting nerve injury during surgery, and suggesting indicators to predict reinnervation after the thyroid surgery. This article reviews the normative data of EMG of each nerve monitored during thyroid surgery and how to interpret events during thyroid surgery using the normative value of EMG.
Troubleshooting algorithm of IONM during thyroid surgery
Seung Hoon Woo 대한신경모니터링학회 2021 Journal of Neuromonitoring & Neurophysiology Vol.1 No.1
This review was conducted on nerve monitoring during thyroid surgery. Intraoperative neuromonitoring is a well-established method used to prevent intraoperative nerve damage, and many studies have been performed in thyroid surgery. We introduced the basic concepts and practical applications, as well as nerve monitoring during surgery and the standardized techniques and details. In addition, the contents of this still yet relatively unknown field, such as its application to the external branches of the superior laryngeal nerve, were summarized by referring to many previous studies.
박다희(Dahee Park),성의숙(Eui-Suk Sung) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.2
Thyroid surgery can cause many complications, but recurrent laryngeal nerve palsy is the most important. Therefore, many efforts have been tried to avoid recurrent laryngeal nerve palsy. Among them, intraoperative neuromonitoring (IONM) is one of the useful tools to find nerves and avoid nerve palsy during surgery. There are various methods, but the method of directly monitoring the movement of the vocal cords using an electromyography tube was introduced first. After that, a method of increasing the signal accuracy by using a pressure sensor and an accelerometer sensor was also introduced. In addition, a needle is directly pierced into the thyroid cartilage or an electrical signal is measured by attaching a sensor to the skin in front of the thyroid cartilage. Various methods of IONM are being tried and studied, and efforts to help find nerves through IONM are continuing. It is expected that overall surgical complications will be reduced by preserving nerves, avoiding changes in voice and swallowing disorders, and reducing the need for tracheostomy due to bilateral vocal cord palsy.
이준규(Joon Kyoo Lee) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.2
Intraoperative neuromonitoring during thyroid surgery has been popularized recently. The majority of this technique represented the direct stimulation to the recurrent laryngeal nerve, so called intermittent intraoperative neuromonitoring (I-IONM). However, continuous monitoring via vagus nerve (C-IONM) was considered more ideal, and has been reported to have more advantage than I-IONM because C-IONM allows the real-time detection of signal changes and prevents the nerve injury before the event. Here, the author reviewed the usefulness of C-IONM.
Use of NMBA and reversal agent during thyroid surgery with intraoperative neuromonitoring
Leerang Lim(Leerang Lim) 대한신경모니터링학회 2023 Journal of Neuromonitoring & Neurophysiology Vol.3 No.1
Neuromuscular blocking agent (NMBA) provides adequate muscle relaxation for intubation and surgery, but their use can interfere with the interpretation of intraoperative neuromonitoring (IONM) signals. Various strategies for the use of NMBA during thyroid surgery with IONM have been proposed for both safe anesthesia and surgery, and adequate quality of IONM. Relaxant-free anesthesia or use of succinylcholine is not recommended as a routine use due to the potential of fatal complications such as laryngeal injury or malignant. Instead, the use of a single dose of rocuronium for intubation with or without a reversal agent has been widely adapted. Though spontaneous recovery of neuromuscular blockade can be achieved without a reversal agent, use of a reversal agent can shorten the time for adequate IONM. Both neostigmine and Sugammadex can be used to reverse the neuromuscular blockade. Neostigmine reverses all types of non-depolarizing NMBA, but can accompany systemic cholinergic effect, and is not effective to deep or higher level of blockade. Sugammadex only reverses the effect of aminosteroid NMBAs, but effective to all levels of blockade. Overall, appropriate strategies for the use of NMBAs and reversal agents are needed to ensure effective IONM without increasing the risk of nerve injury during surgery.