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Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery.
MedLine Citation:
PMID:  22865548     Owner:  NLM     Status:  Publisher    
OBJECTIVES/HYPOTHESIS: Intraoperative neuromonitoring (IONM) facilitates recurrent laryngeal nerve (RLN) identification, but various studies affirm virtually unchanged postoperative RLN palsy rates. Several authors meanwhile suggest continuous intraoperative neuromonitoring (CIONM) via vagal nerve stimulation (VNS) to improve RLN protection. However, knowledge of side effects of electrical VNS derives mainly from its therapeutic applications in the fields of neurology and psychiatry. The presented study was conducted to further evaluate the safety of CIONM and identify possible VNS related side effects. STUDY DESIGN: Prospective nonrandomized controlled trail. METHODS: Forty patients scheduled for thyroid or parathyroid surgery were enrolled in the trail. The intervention group consisted of 22 patients receiving VNS for CIONM. Eighteen patients were operated on with routine IONM. To assess VNS-induced effects on the autonomic nervous system (ANS), heart rate variability analysis (HRVA) was applied. Serum cytokine levels of tumor necrosis factor (TNF)-α were monitored to evaluate immunomodulatory effects of VNS. RESULTS: HRVA revealed significantly increased vagal activity during CIONM. This parasympathetic predominance was not countered by the sympathetic nervous system. Despite a significant increase of vagal tone, no hemodynamic events occurred; in fact, no significant changes in median heart rate or in median arterial blood pressure were detected. Even though anti-inflammatory effects of VNS have been reported, no attenuation of cytokine release of TNF-α was measured. CONCLUSIONS: VNS for CIONM resulted in increased vagal activity assessable via HRVA. The increased parasympathetic tone affected neither hemodynamics nor levels of the proinflammatory cytokine TNF-α. VNS for CIONM appears safe with the applied settings. Laryngoscope, 2012.
Colin Friedrich; Christoph Ulmer; Fabian Rieber; Eva Kern; Andrea Kohler; Karolina Schymik; Klaus-Peter Thon; Wolfram Lamadé
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-1
Journal Detail:
Title:  The Laryngoscope     Volume:  -     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Department of General and Visceral Surgery, Robert Bosch Hospital, Stuttgart; Dr. Margarete Fischer Bosch Institut for Clinical Pharmacology at the Robert Bosch Hospital, Stuttgart, Germany.
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