Schneider Rick, Machens Andreas, Bucher Michael, Raspé Christoph, Heinroth Konstantin, Dralle Henning
Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
Department of Anesthesiology and Surgical Intensive Care, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Langenbecks Arch Surg. 2016 Jun;401(4):551-6. doi: 10.1007/s00423-016-1433-0. Epub 2016 Apr 30.
Intraoperative neuromonitoring of recurrent laryngeal nerve function after stimulation of the vagus nerve has been embraced as a risk minimization tool in thyroid surgery to prevent recurrent laryngeal nerve injury. Because this technology is increasingly used in an elderly and sicker population, the present study was conducted to determine the safety of this method in patients with second- or third-degree atrioventricular block.
This study aimed at evaluating the feasibility and safety of continuous intraoperative neuromonitoring (CIONM) in patients with second- or third-degree atrioventricular block.
A total of six patients (12 nerves at risk), accounting for 0.3 % of all 1800 patients (3049 nerves at risk) who underwent thyroid surgery during the study period, were found to have second- or third-degree atrioventricular block. All these patients maintained normal systolic and diastolic blood pressures; heart rate; and peripheral arterial oxygen saturation before, during, and after CIONM. No clinically relevant changes in heart rate or blood pressure, cardiac arrhythmia, or other hemodynamically important events were noted despite careful monitoring of these patients. There was no interference between the biphasic waveform of the vocal muscle electromyogram and the spikes generated by the implanted cardiac pacemakers. Outcomes were uneventful with normal vocal fold and parathyroid gland function.
Within the limitations of this series and considering experimental, animal, and human data, continuous IONM of the vagus nerve at ≤2 Hz seems to be reasonably safe. Additional research is warranted to confirm these results in larger groups of patients with advanced atrioventricular block.
术中刺激迷走神经后对喉返神经功能进行神经监测已被视为甲状腺手术中降低风险的工具，以预防喉返神经损伤。由于这项技术越来越多地应用于老年及病情较重的人群，因此开展本研究以确定该方法在二度或三度房室传导阻滞患者中的安全性。
本研究旨在评估二度或三度房室传导阻滞患者术中连续神经监测（CIONM）的可行性和安全性。
在研究期间接受甲状腺手术的1800例患者（3049条神经有风险）中，共有6例患者（12条神经有风险）被发现存在二度或三度房室传导阻滞，占比0.3%。所有这些患者在CIONM之前、期间和之后的收缩压、舒张压、心率及外周动脉血氧饱和度均保持正常。尽管对这些患者进行了仔细监测，但未发现心率或血压有临床相关变化、心律失常或其他血流动力学重要事件。声带肌电图的双相波形与植入式心脏起搏器产生的尖峰之间没有干扰。声带和甲状旁腺功能正常，预后良好。
在本系列研究的局限性内，并考虑到实验、动物和人体数据，以≤2Hz的频率对迷走神经进行连续IONM似乎是相当安全的。有必要进行更多研究以在更大规模的晚期房室传导阻滞患者群体中证实这些结果。
