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Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement

Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement

121:S1–S16, 2011 | Gregory W. Randolph, MD; Henning Dralle, MD, with the International Intraoperative Monitoring Study Group*; Hisham Abdullah, MD; Marcin Barczynski, MD; Rocco Bellantone, MD; Michael Brauckhoff, MD; Bruno Carnaille, MD; Sergii Cherenko, MD; Fen-Yu Chiang, MD; Gianlorenzo Dionigi, MD, FACS; Camille Finek, MD; Dana Hartl, MD; Dipti Kamani, MD; Kerstin Lorenz, MD; Paolo Miccoli, MD; Radu Mihai, MD, PhD, FRCS; Akira Miyauchi, MD, PhD; Lisa Orloff, MD, FACS; Nancy Perrier, MD, FACS; Manuel Duran Poveda, MD; Anatoly Romanchinen, MD; Jonathan Serpell, MD, FRACS, FACS; Antonio Sitges-Serra, MD; Tod Sloan, MD, MBA, PhD; Sam Van Slycke, MD; Samuel Snyder, MD, FACS; Hiroshi Takami, MD; Erivelto Volpi, MD; Gayle Woodson, MD
This article presents a comprehensive review of the International Neural Monitoring Study Group's experience and recommendations for electrophysiologic intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery. The group, composed of multidisciplinary experts, aims to standardize IONM practices to improve the quality and consistency of neural monitoring. Key areas addressed include equipment setup, endotracheal tube placement, and loss of signal evaluation. The guidelines emphasize the importance of preoperative and postoperative laryngoscopy, presurgical and postsurgical suprathreshold vagal nerve stimulation, and the use of endotracheal tube-based systems for better waveform documentation. The article also discusses anesthesia protocols, equipment setup standards, and troubleshooting algorithms for common issues such as malpositioned endotracheal tubes and loss of signal. The goal is to minimize variations in monitoring techniques and enhance the accuracy and reliability of IONM.This article presents a comprehensive review of the International Neural Monitoring Study Group's experience and recommendations for electrophysiologic intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery. The group, composed of multidisciplinary experts, aims to standardize IONM practices to improve the quality and consistency of neural monitoring. Key areas addressed include equipment setup, endotracheal tube placement, and loss of signal evaluation. The guidelines emphasize the importance of preoperative and postoperative laryngoscopy, presurgical and postsurgical suprathreshold vagal nerve stimulation, and the use of endotracheal tube-based systems for better waveform documentation. The article also discusses anesthesia protocols, equipment setup standards, and troubleshooting algorithms for common issues such as malpositioned endotracheal tubes and loss of signal. The goal is to minimize variations in monitoring techniques and enhance the accuracy and reliability of IONM.
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