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BJA Advance Access originally published online on February 25, 2005
British Journal of Anaesthesia 2005 94(5):596-600; doi:10.1093/bja/aei110
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions{at}oupjournals.org

Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery

F. Marusch1,*, J. Hussock2, G. Haring2, T. Hachenberg3 and I. Gastinger1

1 Department of Surgery and 2 Department of Anaesthesiology and Intensive Care Medicine, Carl-Thiem-Hospital, Cottbus, Germany. 3 Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke University, Magdeburg, Germany

* Corresponding author. E-mail: marusch-cottbus{at}t-online.de

Background. The influence of muscle relaxation on the intra-operative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery is unclear.

Methods. In a prospective study involving 200 patients undergoing elective thyroid surgery, the influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve was investigated. The patients received balanced anaesthesia with oxygen–nitrous oxide–isoflurane, and rocuronium bromide was used as the non-depolarizing neuromuscular blocking agent. The degree of relaxation was monitored continuously by accelerometry [twitch (% TW)]. Summed action potentials (SAcP) obtained from the vocalis muscle were characterized by the area under the electromyographic curve expressed in millivolt seconds.

Results. Evoked potentials were obtainable in all patients and at all time points. With decreasing neuromuscular blockade a significant increase in the potentials evoked at the vocalis muscle was observed. At 0% TW SAcP was 1.27 (SD 1.02) mV s. An increase in TW to 10% was accompanied by an increase in SAcP to 2.68 (2.01) mV s (P<0.01). At a TW of 25%, mean SAcPs of 5.08 mV s were recorded.

Conclusions. There was a significant difference in the degree of relaxation of the adductor pollicis muscle and the vocalis muscle. The laryngeal muscles exhibited a shorter response time than the adductor pollicis and recovered more quickly. These results confirm the feasibility of intra-operative neuromonitoring of the recurrent laryngeal nerve during neuromuscularblockade.


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