Optimal Depth of NIM EMG Endotracheal Tube for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve During Thyroidectomy

Lu, I-Chen; Chu, Koung‐Shing; Tsai, Chih-Cheng; Wu, Che‐Wei; Kuo, Wen‐Rei; Chen, Hsiu-Ya; Lee, Ka–Wo

doi:10.1007/s00268-008-9549-1

Cited by 109 publications

(114 citation statements)

References 35 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…Surgeon should appreciate the vocal cords are located approximately 1/2 way down the thyroid cartilage. If maximum shunt stimulation occurs at the level of the cricothyroid membrane, anterior arch of the cricoid or lower, one assumes excessive endotracheal tube depth [6][7][8][9][10][11] (c) Repeat laryngoscopy to check correct tube positioning (d) Contralateral VN stimulation. If the contralateral vagus does not have a good EMG reading, a recording side (i.e.…”

Section: Operative Techniquementioning

confidence: 99%

“…We tested and analysed the RLN with stimulation electric current/intensity of 1 mA for definitive confirmation [12]. To optimise the RLN and VN response, we routinely dissected the nerves free from overlying soft tissue, in a strictly bloodless dry field [6][7][8][9][10][11]. The RLN was dissected meticulously to the entry of the larynx.…”

Section: Rln Identification and Stimulationmentioning

confidence: 99%

“…[6][7][8][9][10] The Nerve Integrity Monitor (NIM-Response 2.0 System, Medtronic, Jacksonville, FL, USA) was used to record the amplitude of the EMG signal for the VN and RLN. Nerves were located, mapped and stimulated in the surgical field by the application of a sterile single-use pulse-generated monopolar stimulator probe (Medtronic, Jacksonville, FL, USA).…”

Section: Operative Techniquementioning

confidence: 99%

See 2 more Smart Citations

Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Dionigi

Chiang

Rausei

et al. 2010

Langenbecks Arch Surg

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Operative Techniquementioning

confidence: 99%

Section: Rln Identification and Stimulationmentioning

confidence: 99%

Section: Operative Techniquementioning

confidence: 99%

See 1 more Smart Citation

Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Dionigi

Chiang

Rausei

et al. 2010

Langenbecks Arch Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lu et al studied optimal depth of the NIM EMG tube for RLN monitoring. They found that 5.7% of the tubes required tube depth adjustment, even when placing the tube so that the electrodes were in contact with the vocal cords during direct laryngoscopy [7].…”

Section: Case #3mentioning

confidence: 99%

Use of the GlideScope for placement of a recurrent laryngeal nerve monitoring endotracheal tube

Berkow¹,

Dackiw²,

Tufano³

2011

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

“…The electromyography (EMG) monitoring system represented by Nerve Integrity Monitor (NIM) (Medtronic Xomed, Jacksonville, FL, USA) is useful for RLN and SLNEB preservation in cases in which the tumor is large, or if there is tumor invasion into the adjacent tissue. Recently, RLN monitoring with an EMG has become widely applied (1)(2)(3)(4)(5)(6)(7)(8)(9). Intraoperative nerve monitoring is necessary for nerve function preservation.…”

Section: Introductionmentioning

confidence: 99%

Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery

Ijichi

Sasano

Harima

et al. 2017

Molecular and Clinical Oncology

View full text Add to dashboard Cite

Abstract. In thyroid surgery, intraoperative identification and preservation of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) are crucial. Several reports have proposed that electromyography (EMG) monitoring is an acceptable adjunct for identification and preservation of the RLN. However, a limited number of hospitals have access to an EMG monitoring system. Therefore, the development of another viable monitoring method is required. The aim of the present study was to design a new RLN and SLNEB monitoring method combining an Airwayscope™ (AWS) and a facial nerve stimulator. The facial nerve-stimulating electrode stimulates the RLN or SLNEB, so that the movement of the vocal cord may be observed with an AWS. This monitoring method was performed on 10 patients with a thyroid tumor. In all the cases, RLN and SLNEB were identified and vocal cord function was preserved. All the patients exhibited normal vocal cord function following surgery. Thus, the new RLN and SLNEB monitoring method using an AWS and a facial nerve stimulator is useful in thyroid surgery, and this method may be used as a reliable and available alternative to EMG monitoring to ensure the normal function of the vocal cord. IntroductionIn thyroid surgery, damage to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) is the most serious complication. Therefore, it is necessary to identify and preserve these nerves. The electromyography (EMG) monitoring system represented by Nerve Integrity Monitor (NIM) (Medtronic Xomed, Jacksonville, FL, USA) is useful for RLN and SLNEB preservation in cases in which the tumor is large, or if there is tumor invasion into the adjacent tissue. Recently, RLN monitoring with an EMG has become widely applied (1-9). Intraoperative nerve monitoring is necessary for nerve function preservation. However, not all hospitals are equipped with an EMG monitoring system and, as a result, RLN and SLNEB monitoring is difficult. Therefore, an alternative monitoring method is required, and it was this need that drove us to design a novel RLN and SLNEB monitoring method. When RLN and SLNEB are stimulated with a facial nerve stimulator (FNS), movement of the vocal cord may be observed with an Airwayscope™ (AWS; Ricoh, Tokyo, Japan), more efficiently compared with the laryngeal fiberscope during surgery. The successful combination of these devices was employed as a complete alternative to EMG. In the present study, we were able to not only monitor and preserve the nerves, but also to confirm the absence of RLN injury following resection. Materials and methodsEquipment. AWS is a laryngoscope currently being used for difficult cases of endotracheal intubation under general anesthesia. A fiberscope is attached to the tip of the laryngoscope blade, from which an image is be observed via a 2.5-inch monitor (Fig. 1). An FNS is commonly used in parotid surgery and neurosurgery. The nerve is electrically stimulated by the FNS probe during surgery (Figs. 2 and 3).Metho...

show abstract

Optimal Depth of NIM EMG Endotracheal Tube for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve During Thyroidectomy

Abstract: We concluded that the mean depth of the NIM EMG tube would be a useful reference value for detecting the malposition of electrodes and adjusting the depth of tube during the operation.

Cited by 109 publications

References 35 publications

Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Use of the GlideScope for placement of a recurrent laryngeal nerve monitoring endotracheal tube

Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery

Contact Info

Product

Resources

About