Gastric acid secretion and gastrin release during continuous vagal neuromonitoring in thyroid surgery.

Abstract

The vagus nerve (VN) has essential regulatory roles in the gastric acid secretion and gastrin release. Continuous intraoperative neuromonitoring (CIONM) via VN stimulation is a promising technique in thyroid surgery because it potentially avoids injury to the recurrent laryngeal nerve. However, no studies have investigated changes in gastric acid secretion and gastrin release during CIONM. This prospective study of 58 thyroid surgery patients compared gastric acid and serum gastrin at five time points: (1) before skin incision, (2) after baseline calibration of CIONM probe, (3) +20min from baseline, (4) before probe removal, and (5) after extubation. Patients were excluded if they had any history of using tobacco, acid suppression medications, or drugs that affect gastric motility. Patients were also excluded if they had any history of gastroesophageal reflux symptoms, gastroesophageal reflux disease, peptic ulcer disease, helicobacter pylori infection, or chronic kidney disease. Non significant differences in mean gastric pH values were observed at all time points, i.e., (1) before skin incision (2.2±0.2; p=0.50), (2) after baseline calibration of CIONM probe (2.0±0.8; p=0.62), (3) +20min from baseline (2.5±0.5; p=0.24), (4) before probe removal (2.9±0.9; p=0.52), and (5) after extubation (2.6±1.0; p=0.60). Comparisons of pH monitoring parameters revealed no significant differences in age, gender, side of CIONM (left vs. right), sequence of CIONM, or duration of CIONM. Gastrin values were normal in sequential determinations and did not significantly differ at any time points. CIONM performed via VN stimulation during total thyroidectomy in healthy patients does not influence gastrin secretion and gastric pH.