갑상선수술 중 신경모니터링의 흔한 실패 이유와 그 해결

The various causes of intraoperative neuromonitoring failure and solutions

Thyroid surgery is associated with potential complications, particularly involving the recurrent laryngeal nerve and external branch of the superior laryngeal nerve, which significantly impact patient quality of life. Intraoperative neuromonitoring (IONM) has become a critical tool for preserving nerve function during surgery by providing real- time electromyographic (EMG) feedback. However, the reliability of IONM can be compromised due to various failures during nerve stimulation or EMG signal recording. This study explores the causes of IONM failure and proposes practical solutions to enhance its efficacy. Failures in nerve stimulation are often attributed to device errors, improper settings, or environmental factors such as wet surgical fields. Specific challenges in robotic or endoscopic surgeries, including electrical shunting and cable damage, are also discussed. Additionally, residual neuromuscular blockade from anesthesia can impede nerve response, which may be addressed by adjusting drug protocols or using reversal agents. EMG signal recording failures frequently result from improper positioning of EMG endotracheal tubes. Tube displacement, rotation, or insufficient depth leads to signal loss or false readings. Alternative methods, such as thyroid cartilage needle electrodes, are suggested for improved stability and signal quality. This study emphasizes the importance of a standardized protocol to mitigate IONM failures and enhance the accuracy of nerve monitoring during thyroid surgery. By addressing technical, procedural, and anatomical challenges, the findings contribute to reducing nerve injury, improving surgical outcomes, and ensuring better patient safety and quality of life.