Intraoperative Recurrent Laryngeal Nerve Monitoring During Pediatric Cardiac and Thoracic Surgery: A Mini Review

Area of Science:

• Pediatric Surgery
• Otolaryngology
• Neuromonitoring

Background:

• The recurrent laryngeal nerve (RLN) is vulnerable during pediatric surgeries for conditions like esophageal atresia and tracheoesophageal fistula.
• RLN injury can lead to significant post-operative complications in children.
• Existing literature highlights the utility of intraoperative nerve monitoring in reducing RLN injury rates, particularly in thyroid surgery.

Purpose of the Study:

• To review and discuss techniques for intraoperative recurrent laryngeal nerve (RLN) monitoring specifically in pediatric surgical cases.
• To identify and evaluate methods applicable to cervical, thoracic, and cardiac surgeries where RLNs are at risk.
• To provide an overview of current monitoring strategies for pediatric surgeons.

Main Methods:

• A comprehensive literature review was conducted.
• The review focused on studies reporting intraoperative RLN monitoring in pediatric surgical procedures.
• Techniques suitable for pediatric endotracheal tubes and various surgical approaches were analyzed.

Main Results:

• Pediatric surgeries for esophageal atresia, tracheoesophageal fistula, tracheobronchomalacia, and cardiac procedures pose a risk to the RLN.
• Several intraoperative RLN monitoring techniques are suitable for pediatric patients, including endotracheal tubes with integrated electrodes, adhesive surface electrodes, endolaryngeal electrodes, and automatic periodic continuous intra-operative stimulation.
• Evidence from thyroid surgery suggests intraoperative monitoring can reduce RLN injury rates.

Conclusions:

• Multiple effective techniques for intraoperative RLN monitoring are available for pediatric surgery.
• Implementing RLN monitoring during high-risk pediatric procedures can potentially lower the incidence of nerve injury.
• Continued use and refinement of these techniques are recommended to improve patient outcomes.