Trial reportInternational journal of surgery (London, England)2026
Tracheal intubation in the thyroid surgical position improves recurrent laryngeal nerve monitoring: a dual-center randomized trial.
Trial report in International journal of surgery (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Recent progress in postoperative nausea and vomiting after thyroidectomy.Frontiers in surgery · 2026Review
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntraoperative neuromonitoring (IONM) is a critical adjunct in thyroid surgery to preserve recurrent laryngeal nerve function. This study aims to evaluate whether tracheal intubation in the thyroid surgical position enhances IONM signal quality compared with the standard supine position.
methodsIn this dual-center, parallel-group, randomized trial, 184 adults scheduled for elective thyroidectomy requiring IONM were allocated 1:1 to intubation in either the thyroid surgical position or the conventional supine position. The modified intention-to-treat cohort comprised 167 participants (85 vs 82) with an assessable baseline vagus response (V1). The primary outcome was the incidence of satisfactory electromyography (EMG) signals, defined as an initial vagus nerve EMG amplitude exceeding 500 μV when stimulated at 1.0 mA. Secondary outcomes included EMG signal amplitude, intubation-related metrics (e.g., Cormack-Lehane grades, intubation difficulty scale scores, intubation time, and depth of intubation), postoperative complications (e.g., lip lesions, dental injury, postoperative nausea and vomiting, dizziness, and headache), and clinician satisfaction with patient positioning and mask ventilation.
resultsSatisfactory V1 signals occurred in 82/85 patients (96.47%) in the thyroid surgical position group versus 70/82 (85.37%) in the supine group (relative risk 1.13; 95% CI 1.03-1.24; P = 0.0145). Intubation time and Cormack-Lehane grades did not differ significantly, but the thyroid surgical position group required deeper EMG tube insertion (22 cm [21-23] vs 22 cm [21-22]; median differences 1, 95% CI 0-1; P = 0.046). Postoperative complications did not differ significantly between groups (all P > 0.05). Clinician satisfaction scores were significantly higher in the thyroid surgical position group (median 9 vs 5; median differences 4, 95% CI 3-4; P < 0.0001). Mask ventilation satisfaction was also rated higher in the thyroid surgical position group (median 9 vs 8; median differences 1, 95% CI 0-1 P < 0.0001).
conclusionsTracheal intubation in the thyroid surgical position significantly improves IONM signal quality and clinician satisfaction without increasing intubation difficulty or postoperative complications. Adopting this simple positioning strategy can optimize EMG tube placement and enhance the reliability of IONM during thyroid surgery.
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