Date of this Version

2023

Document Type

DNP Project

Abstract

Background: Injury to the recurrent laryngeal nerve (RLN) is a significant concern in endocrine surgery, accounting for a substantial proportion of negligence litigation and malpractice lawsuits. Failure to identify and monitor the RLN during surgery can lead to transient or permanent vocal cord immobility. Therefore, the use of adjunct monitors for intraoperative neuromonitoring (IONM) is essential to aid in nerve identification and functional assessment. Despite efforts to prevent RLN injury through visual identification, transient and permanent RLN palsy still occur at notable rates. Various devices have been developed to help safely and efficiently preserve and identify the RLN. Continuous IONM (cIONM) offers major advantages. It enables better visualization and identification of the RLN, particularly in high-risk cases and it provides estimates of RLN functional potentials through electric stimulation, which is important as structural integrity does not guarantee functional viability or proper nerve signaling. However, cIONM is limited by frequent false positives, reducing its utility. One common reason for false positives is suboptimal positioning of endotracheal tube electrodes, particularly with devices that are susceptible to movement-related issues. The neural integrity monitoring (NIM) tube, for example, has specific limitations due to its engineering, including precise placement requirements, limited size options, and potential airway complications. On the other hand, disposable adhesive laryngeal electrodes offer a full 360-degree sensor coverage and can be applied to various endotracheal tube sizes, including half-sizes and pediatric tubes. Research supports the use of disposable laryngeal electrodes as efficient, cost-effective, minimally invasive, and user-friendly devices for RLN monitoring. In conclusion, this new technology can help prevent nerve injury by monitoring RLN function, while reducing cost, and improving ease of use.

Methodology: A quality improvement project was conducted on the use of Disposable Laryngeal Electrodes for Intraoperative Neuromonitoring. A pre and post questioner was utilized to assess attitude and knowledge towards the use of disposable laryngeal electrodes. Total N= 8 from a large community based hospital in South Florida.

Results: Attitudes towards the use of disposable laryngeal electrodes increased after the educational module: six participants (75.00%) were most likely, two participants (20.00%) was positive, and two participants (40.00%) were neutral. There were no negative or very negative attitudes expressed with the use of laryngeal electrodes after the educational module

Discussion: There was a statistical difference between the pre- and post-tests, according to the results. The disposable laryngeal knowledge pre-test had an average of 38.00% accurate answers, while the post-test had an average of 88.00% correct answers. Pre-test, 37.00% of providers used laryngeal electrodes, while 62.50% of providers were willing to employ laryngeal electrodes in the post-test. As a result, all respondents showed a considerable improvement in their understanding of laryngeal electrodes and their application, with >50.00% percent change. Overall, there was a 120.00% percent shift in the preference for using laryngeal electrodes in anesthetic practice. All respondents' sentiments about the use of laryngeal electrodes for PONV prevention improved significantly, with a 62.50% percent shift.

Keywords: NIM Tube, Disposable Laryngeal Electrodes, RLN injury, Nerve Monitoring

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