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

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Abstract

Background

Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent laryngeal nerve injury. The purpose of this study was to investigate the optimal depth of the nerve integrity monitor (NIM) EMG endotracheal tube.

Methods

We enrolled 105 adult patients undergoing elective thyroidectomy. Each Medtronic Xomed NIM EMG endotracheal tube was placed with the middle of the exposed electrodes well in contact with the true vocal cords under direct laryngoscopy. Function of IONM was documented and the insertion depth was measured and analyzed.

Results

Ninety-nine (94.3%) patients had successful IONM with the initial endotracheal tube position. Six (5.7%) patients needed further tube depth adjustment under fiberoptic bronchoscopy. All patients were finally had successful IONM. The optimal mean depth was 20.6 ± 0.97 cm in men and 19.6 ± 1.0 cm in women (p < 0.01). There was the trend that taller subjects had a deeper tube depth (p < 0.05).

Conclusion

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.

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Authors and Affiliations

  1. Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Hospital, Kaohsiung, Taiwan

    I-Chen Lu, Koung-Shing Chu, Cheng-Jing Tsai & Hsiu-Ya Chen

  2. Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Koung-Shing Chu

  3. Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Chung-Ho Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan

    Che-Wei Wu, Wen-Rei Kuo, Ka-Wo Lee & Feng-Yu Chiang

  4. Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wen-Rei Kuo, Ka-Wo Lee & Feng-Yu Chiang

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  1. I-Chen Lu
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  2. Koung-Shing Chu
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  3. Cheng-Jing Tsai
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  8. Feng-Yu Chiang
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Correspondence to Feng-Yu Chiang.

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Lu, IC., Chu, KS., Tsai, CJ. et al. Optimal Depth of NIM EMG Endotracheal Tube for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve During Thyroidectomy. World J Surg 32, 1935–1939 (2008). https://doi.org/10.1007/s00268-008-9549-1

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  • DOI: https://doi.org/10.1007/s00268-008-9549-1

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