Nerve monitoring
The use of laryngeal nerve monitoring with a dual-channel electromyographic endotracheal tube is increasingly utilized during thyroid surgery, especially in the hands of higher-volume surgeons (38), although many experienced thyroid surgeons have not incorporated this technology into their practice. Despite lack of definitive evidence that laryngeal nerve monitoring prevents nerve injuries, it may be useful when contemplating outpatient thyroidectomy since the vagus nerve or the most proximal exposed portion of the recurrent laryngeal nerve can be stimulated to confirm its functional integrity at the end of a thyroidectomy (39). Knowledge of the electrophysiologic integrity of the recurrent laryngeal nerve may influence the decision on whether or not to discharge a patient who underwent total thyroidectomy the same day. If one nerve cannot be stimulated at the end of the case and same-day discharge is planned, the patient's respiratory status and swallowing function should be assessed before discharge. If both nerves fail to stimulate by the end of the case, extreme caution must be exercised before extubating the patient. If nerve monitoring is not available or not routinely used, clinical assessment of the patient's respiratory/vocal status as well as flexible laryngoscopy in the postanesthesia care unit may provide real-time assessment of the vocal cord status before discharge