Understanding the variability of the electrophysiologic laryngeal adductor reflex

Mirela V Simon; Seward B Rutkove; Long Ngo; Corey R Fehnel; Alvin S Das; Todd Sarge; Somnath Bose; Magdy Selim; Sandeep Kumar

doi:10.1016/j.clinph.2024.03.019

Understanding the variability of the electrophysiologic laryngeal adductor reflex

Clin Neurophysiol. 2024 Mar 26:162:141-150. doi: 10.1016/j.clinph.2024.03.019. Online ahead of print.

Authors

Mirela V Simon¹, Seward B Rutkove², Long Ngo³, Corey R Fehnel², Alvin S Das², Todd Sarge⁴, Somnath Bose⁴, Magdy Selim², Sandeep Kumar²

Affiliations

¹ Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: mvsimon@mgh.harvard.edu.
² Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁴ Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

PMID: 38631074
DOI: 10.1016/j.clinph.2024.03.019

Abstract

Objective: The laryngeal adductor reflex (LAR) is vital for airway protection and can be electrophysiologically obtained under intravenous general anesthesia (IGA). This makes the electrophysiologic LAR (eLAR) an important tool for monitoring of the vagus nerves and relevant brainstem circuitry during high-risk surgeries. We investigated the intra-class variability of normal and expected abnormal eLAR.

Methods: Repeated measures of contralateral R1 (cR1) were performed under IGA in 58 patients. Data on presence/absence of cR2 and potential confounders were also collected. Review of neuroimaging, pathology and clinical exam, allowed classification into normal and expected abnormal eLAR groups. Using univariate and multivariate analysis we studied the variability of cR1 parameters and their differences between the two groups.

Results: In both groups, cR1 latencies had coefficients of variation of <2%. In the abnormal group, cR1 had longer latencies, required higher activation currents and was more frequently desynchronized and unsustained; cR2 was more frequently absent.

Conclusions: cR1 latencies show high analytical precision for measurements. Delayed onset, difficult to elicit, desynchronized and unsustained cR1, and absence of cR2 signal an abnormal eLAR.

Significance: Understanding the variability and behavior of normal and abnormal eLAR under IGA can aid in the interpretation of its changes during monitoring.

Keywords: Airway protection; Amplitude; Duration; Laryngeal adductor reflex; Latency; cR1.