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Updated: Mar 12, 2026

Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
Published on: February 11, 2019
Failed Vocalis Muscle Monitoring During Thyroid Surgery Resulting From Residual Muscle Relaxation
Marie-Luise Ruebsam1, Christian Hoenemann
1From the *Department of Anesthesiology, Intensive Care and Emergency Medicine, St Marienhospital Vechta, Vechta, Germany; and the †Department of Anesthesiology and Intensive Care, Klinikum Leer gGmbH, Leer, Germany.
Abstract:
Postoperative paralysis of the vocal cords resulting from intraoperative surgical injury of the recurrent laryngeal nerve is one of the most serious complications of elective thyroid surgery. The chance of injury is reduced by using intraoperative neuromonitoring (IONM). This educational report describes a case of IONM failure resulting from residual muscle relaxation that was restored by administration of sugammadex. It discusses possible pharmacology explanations and provides recommendations for how to prevent this situation in daily practice.
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