• Alvaro A Macias, Sunil Eappen, Ilya Malikin, Jeremy Goldfarb, Sharon Kujawa, Paul M Konowitz, Dipti Kamani, and Gregory W Randolph.
• Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
• Head Neck. 2016 Oct 1; 38 (10): 1487-94.

BackgroundAlthough intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.MethodsThe Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period.ResultsNo complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors.ConclusionAn IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1494, 2016.© 2016 Wiley Periodicals, Inc.

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