Kirschbaum Andreas, Jochens Nora, Stay David, Meyer Christian, Bartsch Detlef K
Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany.
Department of Anesthesiology and Intensive Medicine, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany.
J Thorac Dis. 2023 Aug 31;15(8):4198-4206. doi: 10.21037/jtd-22-1515. Epub 2023 Jul 13.
The recurrent laryngeal nerve (RLN), especially on the left side, is particularly vulnerable during lung operations. Therefore, continuous intraoperative neuromonitoring (cIONM) would be desirable. With the use of a double-lumen tube (DLT) for single-lung ventilation, there is some uncertainty where the recording electrode should be positioned. The aim of this study was to assess the feasibility of this technique and to predict the ideal position of a single recording electrode.
Patients scheduled to undergo left thoracotomy due to pulmonary pathologies, two adhesive electrodes were affixed consecutively above the proximal cuff of the DLT prior to intubation for a precise location of the recording from the vocal cords. Following thoracotomy, the vagus nerve alongside the aortic arch was exposed. A continuous stimulation probe (Saxophone electrode, Dr. Langer Medical, Waldkirch, Germany) was placed around the nerve. The signals of the respective electrode were recorded and analyzed with regard to previously defined limits of positive signaling.
Strong signals with an amplitude of at least 165 µV were recorded in 18 of 20 patients. In these patients 100% of the signals were recorded via the distally located electrode. An additional signal was recorded via the proximal electrode in four patients. cIONM was found to be a safe and reproducible technique.
The described technique enables the use of cIONM of the RLN throughout the entire course of the surgical procedure.
喉返神经（RLN），尤其是左侧喉返神经，在肺部手术中特别容易受到损伤。因此，术中连续神经监测（cIONM）是可取的。在使用双腔气管导管（DLT）进行单肺通气时，记录电极应放置在何处存在一些不确定性。本研究的目的是评估该技术的可行性，并预测单个记录电极的理想位置。
因肺部疾病计划接受左胸切开术的患者，在插管前，将两个粘性电极连续固定在DLT近端套囊上方，以便精确记录声带的信号。开胸后，暴露主动脉弓旁的迷走神经。将一个连续刺激探头（萨克斯风电极，德国瓦尔德基希的兰格博士医疗公司）放置在神经周围。记录并分析各个电极的信号，以确定先前定义的阳性信号限度。
20例患者中有18例记录到幅度至少为165µV的强信号。在这些患者中，100%的信号是通过位于远端的电极记录的。另外4例患者通过近端电极记录到了额外的信号。发现cIONM是一种安全且可重复的技术。
所描述的技术能够在整个手术过程中对喉返神经进行术中连续神经监测。
