Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery: Results from the Porcine Experiment

Kim, Hoon Yub; Tufano, Ralph P.; Randolph, Gregory W.; Barczyński, Marcin; Wu, Che‐Wei; Liu, Xiaoli; Masuoka, Hiroo; Miyauchi, Akira; Park, Soo Young; Kwak, Hyun Jung; Lee, Hye Yoon; Dionigi, Gianlorenzo

doi:10.1002/hed.24145

Cited by 50 publications

(57 citation statements)

References 12 publications

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“…Additionally, C-IONM provides comprehensive electromyography (EMG) documentation, detects imminent RLN failure, and reveals RLN stress mechanisms. Finally, C-IONM can reveal malposition of an EMG tube (7,8,12).…”

Section: C-ionm Of the Rln Via Vagal Nerve (Vn) Stimulation: A Promismentioning

confidence: 99%

“…Nerve function can then be preserved by taking appropriate corrective action and by aborting maneuvers that can potentially cause adverse EMG changes and permanent vocal cord paralysis (VCP) (7,8). However, thyroid surgeons require effective methods for identifying important adverse events and for differentiating between true adverse events and artifacts (7,8,12). Additionally, amplitude reductions and latency increases detected by C-IONM can reveal a mild combined events (mCEs) or severe combined events (sCEs) ( Table 6).…”

Section: C-ionm Of the Rln Via Vagal Nerve (Vn) Stimulation: A Promismentioning

confidence: 99%

“…A baseline V1 amplitude of >500 μV indicates a functionally intact RLN and is considered a prerequisite for RLN diagnosis and for further interpretation of reduction of signal, recovery signal, LOS, preoperative VCP (nerve conduction\EMG signal preserved) (7,8,12).…”

Section: Endotracheal Emg Tubementioning

confidence: 99%

“…A thorough introduction to C-IONM requires a critical evaluation of neuromonitoring devices available in the near future (7,8,12 Amplitude decrease of 50%-70% with a concordant latency increase of 5%-10% sCE Amplitude decrease of 70% with a concordant latency increase of 10% C-IONM = continuous intraoperative nerve monitoring; mCE = mild combined event; sCE = severe combined event.…”

Section: Endotracheal Emg Tubementioning

confidence: 99%

“…The EMG signal detected by C-IONM can also be affected by the anesthesia type, by manipulation of the trachea, and by dislocation of the VN electrode (acute LOS indicates electrode dislocation) (12).…”

Section: Endotracheal Emg Tubementioning

confidence: 99%

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Future Directions of Neural Monitoring in Thyroid Surgery

Kim

Liu

et al. 2017

J Endocr Surg

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Dissecting and identifying the recurrent laryngeal nerve (RLN) are considered routine procedures now that safe and effective methods have been established. Preventing RLN injury during thyroid surgery requires good visualization and exposure of the RLN, adequate knowledge of RLN anatomy, adequate surgical experience and training, and pre-and postoperative laryngoscopy. Whereas these requirements are widely accepted for routine thyroid surgery, new technical developments have emerged in the past 15 years. Literature show that both intermittent intraoperative neural monitoring (I-IONM) and continuous IONM (C-IONM) are recognized as effective techniques for RLN. The aim of this paper is to discuss advantages, limits and possible future directions for use of IONM and C-IONM in thyroid and parathyroid surgery.

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Section: C-ionm Of the Rln Via Vagal Nerve (Vn) Stimulation: A Promismentioning

confidence: 99%

Section: C-ionm Of the Rln Via Vagal Nerve (Vn) Stimulation: A Promismentioning

confidence: 99%

Section: Endotracheal Emg Tubementioning

confidence: 99%

Section: Endotracheal Emg Tubementioning

confidence: 99%

Section: Endotracheal Emg Tubementioning

confidence: 99%

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Future Directions of Neural Monitoring in Thyroid Surgery

Kim

Liu

et al. 2017

J Endocr Surg

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Twenty-year experience of paediatric thyroid surgery using intraoperative nerve monitoring

Schneider

Machens

Sekulla

et al. 2018

British Journal of Surgery

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Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery

Zhao

et al. 2019

Journal of British Surgery

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Background Needle electrodes placed on the thyroid cartilage (TC) are an alternative to endotracheal tube (ET) electrodes for assessing recurrent laryngeal nerve (RLN) function during thyroid surgery. Needle electrodes placed on the TC were evaluated in an experimental porcine model. Methods Continuous intraoperative neuromonitoring was used to record the electromyogram. Each TC side was delineated into nine areas to determine the optimal placement of the electrode, and needle electrode area, depth and orientation for optimal electromyographic (EMG) amplitudes were evaluated. RLN root locations were stimulated at four locations: vagus nerve distal to the neuromonitoring electrode, and most proximal, middle and laryngeal entry points of the nerve. A nerve retraction injury model was adapted to compare RLN monitoring by TC versus ET electrodes. Results An optimal site for placement of needle electrodes was identified, and electromyograms obtained from the various needle insertion depths and orientations were similar. Latencies recorded from the TC and ET electrodes were similar. The amplitude profile of TC electrodes responded earlier to RLN injury than that of ET electrodes. Amplitude and drop to loss of signal were also registered earlier. Conclusion EMG amplitudes obtained using TC electrodes were higher, and identified RLN injury earlier than ET electrodes. Needle electrodes placed on the thyroid cartilage (TC) are an alternative to endotracheal tube (ET) electrodes for assessing the function of the recurrent laryngeal nerve (RLN) in thyroid surgery.This study used an experimental porcine model to evaluate the use of needle electrodes inserted in the TC, compared with ET electrodes, for producing an electromyographic (EMG) profile of the RLN. Nine areas of the TC, with various needle insertion depths and orientations, were compared. Perichondral insertion into the avascular area of the TC was found to be safe. The EMG amplitude and latency features recorded via the TC and ET electrodes were compared, using both intermittent and continuous monitoring. Changes in EMG amplitudes in response to nerve traction injury were registered earlier with TC electrodes than with ET electrodes, and the amplitudes were higher and more stable. Latencies obtained via the TC and ET electrodes were similar.These results indicate that the development of a non‐invasive monitoring electrode with improved function, easy placement and low cost is possible.

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Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery: Results from the Porcine Experiment

Cited by 50 publications

References 12 publications

Future Directions of Neural Monitoring in Thyroid Surgery

Future Directions of Neural Monitoring in Thyroid Surgery

Twenty-year experience of paediatric thyroid surgery using intraoperative nerve monitoring

Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery

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