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Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials / Álvaro Enrique Sanabria Quiroga
Título : Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroidectomy laryngeal nerve injuries neuromonitoring meta-analysis systematic review Resumen : Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification. RCTs comparing routine neuromonitoring versus no use in patients who underwent elective partial or total thyroidectomy were evaluated. Outcomes measured were temporary and definitive palsy of the RLN and EBSLN. A systematic review and meta-analysis was done using random effects model. GRADE was used to classify quality of evidence. Six studies with 1,602 patients and 3,064 nerves at risk were identified. Methodological quality assessment showed high risk of bias in most items. Funnel plot did not reveal publication bias. The risk difference for temporary RLN palsy, definitive RLN palsy, temporary EBSLN palsy, and definitive EBSLN palsy were −2 % (95 % confidence interval −5.1 to 1); 0 % (−1 to 1); −9 % (−15 to −2) and −1 % (−4 to 2), respectively. Quality was rated low or very low in most outcomes due to methodological flaws. Meta-analysis did not demonstrate a statistically significant decrease in the risk of temporary or definitive RLN injury and definitive EBSLN injury with the use of neuromonitoring. The neuromonitoring group had a statistically significant decrease in the risk of temporary EBSLN injury. Mención de responsabilidad : Alvaro Sanabria, Adonis Ramirez, Luiz P Kowalski, Carl E Silver, Ashok R Shaha, Randall P Owen, Carlos Suárez, Avi Khafif, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Aug;270(8):2175-89. DOI (Digital Object Identifier) : 10.1007/s00405-013-2557-2 PMID : 23681545 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2557-2 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3714 Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials [documento electrónico] / Álvaro Enrique Sanabria Quiroga, . - 2013.
Obra : European Archives of Oto-rhino-laryngology
Idioma : Inglés (eng)
Palabras clave : Thyroidectomy laryngeal nerve injuries neuromonitoring meta-analysis systematic review Resumen : Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification. RCTs comparing routine neuromonitoring versus no use in patients who underwent elective partial or total thyroidectomy were evaluated. Outcomes measured were temporary and definitive palsy of the RLN and EBSLN. A systematic review and meta-analysis was done using random effects model. GRADE was used to classify quality of evidence. Six studies with 1,602 patients and 3,064 nerves at risk were identified. Methodological quality assessment showed high risk of bias in most items. Funnel plot did not reveal publication bias. The risk difference for temporary RLN palsy, definitive RLN palsy, temporary EBSLN palsy, and definitive EBSLN palsy were −2 % (95 % confidence interval −5.1 to 1); 0 % (−1 to 1); −9 % (−15 to −2) and −1 % (−4 to 2), respectively. Quality was rated low or very low in most outcomes due to methodological flaws. Meta-analysis did not demonstrate a statistically significant decrease in the risk of temporary or definitive RLN injury and definitive EBSLN injury with the use of neuromonitoring. The neuromonitoring group had a statistically significant decrease in the risk of temporary EBSLN injury. Mención de responsabilidad : Alvaro Sanabria, Adonis Ramirez, Luiz P Kowalski, Carl E Silver, Ashok R Shaha, Randall P Owen, Carlos Suárez, Avi Khafif, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Aug;270(8):2175-89. DOI (Digital Object Identifier) : 10.1007/s00405-013-2557-2 PMID : 23681545 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2557-2 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3714 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000287 AC-2013-055 Archivo digital Producción Científica Artículos científicos Disponible Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature / Álvaro Enrique Sanabria Quiroga
Título : Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland laryngeal nerve injuries neuromuscular monitoring thyroidectomy tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713 Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature [documento electrónico] / Álvaro Enrique Sanabria Quiroga, . - 2013.
Obra : European Archives of Oto-rhino-laryngology
Idioma : Inglés (eng)
Palabras clave : Thyroid gland laryngeal nerve injuries neuromuscular monitoring thyroidectomy tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000286 AC-2013-054 Archivo digital Producción Científica Artículos científicos Disponible