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Facial Nerve Monitoring Parotid Surgery — FRCA Final MCQ

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ModerateGeneral AnaesthesiaFacial Nerve Monitoring Parotid SurgeryFRCA Final

A 35-year-old man (ASA I) undergoes excision of a parotid pleomorphic adenoma under general anaesthesia. The surgeon requests that the anaesthetist avoids using neuromuscular blocking agents during the procedure. What is the most likely reason?

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Correct answer: B — The surgeon plans to use a facial nerve stimulator for intraoperative monitoring

During parotid surgery, the facial nerve (CN VII) runs through the parotid gland and is at risk of injury during tumour excision. The surgeon uses a nerve stimulator to identify and preserve the facial nerve by observing facial muscle twitching when the nerve is stimulated. Neuromuscular blocking agents would prevent muscle twitching and render the nerve stimulator useless. If NMBAs are used for intubation, they must be fully reversed (TOF ratio >0.9) before the surgeon begins dissection near the facial nerve. Alternatively, a remifentanil/propofol technique without NMBAs can be used.

Reference: RCOA – 2023 – Head and neck anaesthesia module; BAOMS – 2019 – Parotid surgery guidelines