Sinclair Catherine F, Téllez Maria J, Tapia Oscar R, Ulkatan Sedat
Department of Otolaryngology Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, U.S.A.
Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York, U.S.A.
Laryngoscope. 2017 Dec;127(12):E443-E448. doi: 10.1002/lary.26744. Epub 2017 Aug 4.
To demonstrate that under total intravenous general anesthesia (TIVA), the contralateral R1 (cRI) and contralateral R2 (cR2) components of the laryngeal adductor reflex (LAR) can be reliably elicited; to determine effects of topical anesthesia and inhalational anesthesia on the LAR; and to discuss how this technique may be utilized to continuously monitor the vagus nerve reflex arc.
Case series.
Vocal fold mucosa was electrically stimulated via endotracheal tube surface-based electrodes to elicit a LAR. Responses were recorded using the endotracheal tube electrode contralateral to the simulating electrode for each side.
Twenty-one patients (31 nerves at risk), aged between 28 to 84 years, who underwent thyroid and cervical spine surgeries (4 males, 17 females) were included. cR1 responses were reliably elicited in all patients, and cR2 responses were obtained in 14 patients (66.6%). Mean cR1 latencies ± standard deviation were 22.5 ± 2.5 milliseconds (ms) (left) and 23.4 ± 3.3 ms (right). Mean cR1 amplitudes were 237.9 ± 153.9 microvolts (uV) (left) and 265.0 ± 226.5 uV (right). Mean R2 latencies were 59.8 ± 4.9 ms (left) and 61.8 ± 7.9 ms (right). Intraoperative reversible cR1 amplitude decreases correlated temporally with surgical maneuvers stretching or compressing the RLN or internal branch of the superior laryngeal nerve (iSLN). Inhalational anesthetic agents abolished cR2 and minimized cR1 at mean alveolar concentrations > 0.5. Topical lidocaine significantly reduced LAR amplitude.
LAR cR1 and cR2 responses are present in humans under TIVA and may afford some airway protection against aspiration under anesthesia. They are inhibited by inhalational anesthetics and topical lidocaine. Continuous intraoperative iSLN and RLN monitoring are possible using surface-based endotracheal tube electrodes alone to stimulate and record cR1 responses.
证明在全静脉全身麻醉（TIVA）下，喉内收肌反射（LAR）的对侧R1（cRI）和对侧R2（cR2）成分能够被可靠引出；确定表面麻醉和吸入麻醉对LAR的影响；并讨论如何利用该技术持续监测迷走神经反射弧。
病例系列。
通过基于气管导管表面的电极对声带黏膜进行电刺激以引出LAR。使用与每侧模拟电极对侧的气管导管电极记录反应。
纳入21例年龄在28至84岁之间接受甲状腺和颈椎手术的患者（31条神经有风险）（4例男性，17例女性）。所有患者均可靠引出cR1反应，14例患者（66.6%）获得cR2反应。cR1平均潜伏期±标准差为左侧22.5±2.5毫秒（ms），右侧23.4±3.3 ms。cR1平均波幅为左侧237.9±153.9微伏（uV），右侧265.0±226.5 uV。R2平均潜伏期为左侧59.8±4.9 ms，右侧61.8±7.9 ms。术中cR1波幅的可逆性降低在时间上与牵拉或压迫喉返神经（RLN）或喉上神经内支（iSLN）的手术操作相关。吸入麻醉药在平均肺泡浓度>0.5时可消除cR2并使cR1最小化。表面利多卡因显著降低LAR波幅。
在TIVA下，人类存在LAR的cR1和cR2反应，并可能在麻醉下为气道提供一定的误吸保护。它们受到吸入麻醉药和表面利多卡因的抑制。仅使用基于气管导管表面的电极来刺激和记录cR1反应，术中持续监测iSLN和RLN是可行的。
4。《喉镜》，127：E443 - E448，2017年。
