Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury

Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Smith, Joshua D. [verfasserIn] Mentz, Graciela Leis, Aleda M. Yuan, Yuan Stucken, Chaz L. Chinn, Steven B. Casper, Keith A. Malloy, Kelly M. Shuman, Andrew G. McLean, Scott A. Rosko, Andrew J. Prince, Mark E. P. Tremper, Kevin K. Spector, Matthew E. Schechtman, Samuel A.

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Neck dissection Lymphadenectomy Nerve monitoring Neuromuscular blockade Nerve Injury Iatrogenic

Anmerkung:	© The Author(s) 2023

Übergeordnetes Werk:	Enthalten in: BMC anesthesiology - [S.l.] : BioMed Central, 2001, 23(2023), 1 vom: 28. Juli
Übergeordnetes Werk:	volume:23 ; year:2023 ; number:1 ; day:28 ; month:07

Links:	Volltext

DOI / URN:	10.1186/s12871-023-02217-7

Katalog-ID:	SPR052566277

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520			\|a Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary.
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allfields	10.1186/s12871-023-02217-7 doi (DE-627)SPR052566277 (SPR)s12871-023-02217-7-e DE-627 ger DE-627 rakwb eng Smith, Joshua D. verfasserin aut Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. Neck dissection (dpeaa)DE-He213 Lymphadenectomy (dpeaa)DE-He213 Nerve monitoring (dpeaa)DE-He213 Neuromuscular blockade (dpeaa)DE-He213 Nerve (dpeaa)DE-He213 Injury (dpeaa)DE-He213 Iatrogenic (dpeaa)DE-He213 Mentz, Graciela aut Leis, Aleda M. aut Yuan, Yuan aut Stucken, Chaz L. aut Chinn, Steven B. aut Casper, Keith A. aut Malloy, Kelly M. aut Shuman, Andrew G. aut McLean, Scott A. aut Rosko, Andrew J. aut Prince, Mark E. P. aut Tremper, Kevin K. aut Spector, Matthew E. aut Schechtman, Samuel A. aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 23(2023), 1 vom: 28. Juli (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:23 year:2023 number:1 day:28 month:07 https://dx.doi.org/10.1186/s12871-023-02217-7 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 23 2023 1 28 07
spelling	10.1186/s12871-023-02217-7 doi (DE-627)SPR052566277 (SPR)s12871-023-02217-7-e DE-627 ger DE-627 rakwb eng Smith, Joshua D. verfasserin aut Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. Neck dissection (dpeaa)DE-He213 Lymphadenectomy (dpeaa)DE-He213 Nerve monitoring (dpeaa)DE-He213 Neuromuscular blockade (dpeaa)DE-He213 Nerve (dpeaa)DE-He213 Injury (dpeaa)DE-He213 Iatrogenic (dpeaa)DE-He213 Mentz, Graciela aut Leis, Aleda M. aut Yuan, Yuan aut Stucken, Chaz L. aut Chinn, Steven B. aut Casper, Keith A. aut Malloy, Kelly M. aut Shuman, Andrew G. aut McLean, Scott A. aut Rosko, Andrew J. aut Prince, Mark E. P. aut Tremper, Kevin K. aut Spector, Matthew E. aut Schechtman, Samuel A. aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 23(2023), 1 vom: 28. Juli (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:23 year:2023 number:1 day:28 month:07 https://dx.doi.org/10.1186/s12871-023-02217-7 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 23 2023 1 28 07
allfields_unstemmed	10.1186/s12871-023-02217-7 doi (DE-627)SPR052566277 (SPR)s12871-023-02217-7-e DE-627 ger DE-627 rakwb eng Smith, Joshua D. verfasserin aut Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. Neck dissection (dpeaa)DE-He213 Lymphadenectomy (dpeaa)DE-He213 Nerve monitoring (dpeaa)DE-He213 Neuromuscular blockade (dpeaa)DE-He213 Nerve (dpeaa)DE-He213 Injury (dpeaa)DE-He213 Iatrogenic (dpeaa)DE-He213 Mentz, Graciela aut Leis, Aleda M. aut Yuan, Yuan aut Stucken, Chaz L. aut Chinn, Steven B. aut Casper, Keith A. aut Malloy, Kelly M. aut Shuman, Andrew G. aut McLean, Scott A. aut Rosko, Andrew J. aut Prince, Mark E. P. aut Tremper, Kevin K. aut Spector, Matthew E. aut Schechtman, Samuel A. aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 23(2023), 1 vom: 28. Juli (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:23 year:2023 number:1 day:28 month:07 https://dx.doi.org/10.1186/s12871-023-02217-7 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 23 2023 1 28 07
allfieldsGer	10.1186/s12871-023-02217-7 doi (DE-627)SPR052566277 (SPR)s12871-023-02217-7-e DE-627 ger DE-627 rakwb eng Smith, Joshua D. verfasserin aut Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. Neck dissection (dpeaa)DE-He213 Lymphadenectomy (dpeaa)DE-He213 Nerve monitoring (dpeaa)DE-He213 Neuromuscular blockade (dpeaa)DE-He213 Nerve (dpeaa)DE-He213 Injury (dpeaa)DE-He213 Iatrogenic (dpeaa)DE-He213 Mentz, Graciela aut Leis, Aleda M. aut Yuan, Yuan aut Stucken, Chaz L. aut Chinn, Steven B. aut Casper, Keith A. aut Malloy, Kelly M. aut Shuman, Andrew G. aut McLean, Scott A. aut Rosko, Andrew J. aut Prince, Mark E. P. aut Tremper, Kevin K. aut Spector, Matthew E. aut Schechtman, Samuel A. aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 23(2023), 1 vom: 28. Juli (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:23 year:2023 number:1 day:28 month:07 https://dx.doi.org/10.1186/s12871-023-02217-7 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 23 2023 1 28 07
allfieldsSound	10.1186/s12871-023-02217-7 doi (DE-627)SPR052566277 (SPR)s12871-023-02217-7-e DE-627 ger DE-627 rakwb eng Smith, Joshua D. verfasserin aut Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. Neck dissection (dpeaa)DE-He213 Lymphadenectomy (dpeaa)DE-He213 Nerve monitoring (dpeaa)DE-He213 Neuromuscular blockade (dpeaa)DE-He213 Nerve (dpeaa)DE-He213 Injury (dpeaa)DE-He213 Iatrogenic (dpeaa)DE-He213 Mentz, Graciela aut Leis, Aleda M. aut Yuan, Yuan aut Stucken, Chaz L. aut Chinn, Steven B. aut Casper, Keith A. aut Malloy, Kelly M. aut Shuman, Andrew G. aut McLean, Scott A. aut Rosko, Andrew J. aut Prince, Mark E. P. aut Tremper, Kevin K. aut Spector, Matthew E. aut Schechtman, Samuel A. aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 23(2023), 1 vom: 28. Juli (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:23 year:2023 number:1 day:28 month:07 https://dx.doi.org/10.1186/s12871-023-02217-7 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 23 2023 1 28 07
language	English
source	Enthalten in BMC anesthesiology 23(2023), 1 vom: 28. Juli volume:23 year:2023 number:1 day:28 month:07
sourceStr	Enthalten in BMC anesthesiology 23(2023), 1 vom: 28. Juli volume:23 year:2023 number:1 day:28 month:07
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Neck dissection Lymphadenectomy Nerve monitoring Neuromuscular blockade Nerve Injury Iatrogenic
isfreeaccess_bool	true
container_title	BMC anesthesiology
authorswithroles_txt_mv	Smith, Joshua D. @@aut@@ Mentz, Graciela @@aut@@ Leis, Aleda M. @@aut@@ Yuan, Yuan @@aut@@ Stucken, Chaz L. @@aut@@ Chinn, Steven B. @@aut@@ Casper, Keith A. @@aut@@ Malloy, Kelly M. @@aut@@ Shuman, Andrew G. @@aut@@ McLean, Scott A. @@aut@@ Rosko, Andrew J. @@aut@@ Prince, Mark E. P. @@aut@@ Tremper, Kevin K. @@aut@@ Spector, Matthew E. @@aut@@ Schechtman, Samuel A. @@aut@@
publishDateDaySort_date	2023-07-28T00:00:00Z
hierarchy_top_id	355422115
id	SPR052566277
language_de	englisch
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We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. 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author	Smith, Joshua D.
spellingShingle	Smith, Joshua D. misc Neck dissection misc Lymphadenectomy misc Nerve monitoring misc Neuromuscular blockade misc Nerve misc Injury misc Iatrogenic Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
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topic_title	Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury Neck dissection (dpeaa)DE-He213 Lymphadenectomy (dpeaa)DE-He213 Nerve monitoring (dpeaa)DE-He213 Neuromuscular blockade (dpeaa)DE-He213 Nerve (dpeaa)DE-He213 Injury (dpeaa)DE-He213 Iatrogenic (dpeaa)DE-He213
topic	misc Neck dissection misc Lymphadenectomy misc Nerve monitoring misc Neuromuscular blockade misc Nerve misc Injury misc Iatrogenic
topic_unstemmed	misc Neck dissection misc Lymphadenectomy misc Nerve monitoring misc Neuromuscular blockade misc Nerve misc Injury misc Iatrogenic
topic_browse	misc Neck dissection misc Lymphadenectomy misc Nerve monitoring misc Neuromuscular blockade misc Nerve misc Injury misc Iatrogenic
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title	Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
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title_full	Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
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author_browse	Smith, Joshua D. Mentz, Graciela Leis, Aleda M. Yuan, Yuan Stucken, Chaz L. Chinn, Steven B. Casper, Keith A. Malloy, Kelly M. Shuman, Andrew G. McLean, Scott A. Rosko, Andrew J. Prince, Mark E. P. Tremper, Kevin K. Spector, Matthew E. Schechtman, Samuel A.
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author-letter	Smith, Joshua D.
doi_str_mv	10.1186/s12871-023-02217-7
title_sort	use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title_auth	Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
abstract	Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. © The Author(s) 2023
abstractGer	Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. © The Author(s) 2023
abstract_unstemmed	Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. © The Author(s) 2023
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title_short	Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
url	https://dx.doi.org/10.1186/s12871-023-02217-7
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author2	Mentz, Graciela Leis, Aleda M. Yuan, Yuan Stucken, Chaz L. Chinn, Steven B. Casper, Keith A. Malloy, Kelly M. Shuman, Andrew G. McLean, Scott A. Rosko, Andrew J. Prince, Mark E. P. Tremper, Kevin K. Spector, Matthew E. Schechtman, Samuel A.
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Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury

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