Thyroid surgery is associated with vocal cord palsy due to recurrent laryngeal nerve damage from traction, contusion or transection: Temporary unilateral vocal cord paralysis 3–4% Permanent unilateral vocal cord paralysis <1% Bilateral vocal cord paralysis...
RLN is based on recording of evoked potentials via EMG at the vocalis muscle: Relies on a functioning neuromuscular junction Cannot be performed if neuromuscular blockers are administered EMG monitoring involves the use of 2 separate circuits – a stimulating...
Oral intubation is usually required given the rigidity and added bulk of the tubes It is essential to ensure the electrodes are contacting adequately at the level of the vocal cords for accurate monitoring: Middle of the blue marked region should contact the true...
Switch to manual ventilation Close the APL valve completely Gently squeeze the reservoir bag, watching the airway pressure, until a pressure of 20-30cm H2O is achieved Hold for 10 seconds Ensure to place back on ventilatory support...
ABC assessment Manoeuvres to relieve dyspnoea: Administer high flow oxygen Sit the patient up Remove surgical clips/sutures: Allows decompression of the haematoma Ensure G&S performed and blood available Ensure appropriate support: ENT surgeon Senior anaesthetist...
