Has anybody experience with cardioversion during thyroid surgery with intraoperative continuous neuromonitoring via endotracheal tube electrode?
Today I received an answer to my question from industry:
There is no answer to this question!
Despite the fact, that our patients have more and more co-morbiditie,s there is no study answering this question. The only solution proposed was to use needle electrodes and to remove them before cardioversion.
This was the way I used to handle this problem more than 10 - 15 years ago, before the introduction of non-invasive electrodes connected to the endotracheal tubes. It is a funny thing to consider that there was no progress meanwhile.
I probably wouldnt go on thyroid surgery if the patient got cardiac emergency during the surgery. Even if i did, i wouldnt try to see the nerve and would perform a subtotal thyroidectomy. Do you have experience on that?
Today, patients are sicker than 20 years ago and we still find more devices inside a patient. I t was not the question to avoid surgery, but still what to do if you need defibrillation during surgery - by internal or external device. Surgery without preparation of the recurrent nerve is not state of the art anymore despite a controlled randomized study of B. koch during the 90-ties in Germany, which demonstrated no differenc between visualizing the nerve or not in subtotal resection or in hemithyreoidectomy.
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