Original Article

Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model^†

Che-Wei Wu MD

Department of Otolaryngology, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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I-Cheng Lu MD,

I-Cheng Lu MD

Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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Gregory W. Randolph MD,

Gregory W. Randolph MD

Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Wen-Rei Kuo MD,

Wen-Rei Kuo MD

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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Ka-Wo Lee MD,

Ka-Wo Lee MD

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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Chang-Lin Chen MD,

Chang-Lin Chen MD

Department of Ophthalmology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung City, Taiwan

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Feng-Yu Chiang MD,

Corresponding Author

Feng-Yu Chiang MD

[email protected]

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, TaiwanSearch for more papers by this author

Che-Wei Wu MD,

Che-Wei Wu MD

Department of Otolaryngology, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

Search for more papers by this author

I-Cheng Lu MD,

I-Cheng Lu MD

Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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Gregory W. Randolph MD,

Gregory W. Randolph MD

Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Wen-Rei Kuo MD,

Wen-Rei Kuo MD

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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Ka-Wo Lee MD,

Ka-Wo Lee MD

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

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Chang-Lin Chen MD,

Chang-Lin Chen MD

Department of Ophthalmology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung City, Taiwan

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Feng-Yu Chiang MD,

Corresponding Author

Feng-Yu Chiang MD

[email protected]

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan

Department of Otolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, TaiwanSearch for more papers by this author

First published: 20 January 2010

https://doi.org/10.1002/hed.21324

Citations: 56

^†

Part of this work was presented at the World Congress on Thyroid Cancer (WCTC), Toronto, Canada, August 6–10, 2009, and the First Congress of Asian Society of Head and Neck Oncology (ASHNO), Taipei, Taiwan, September 17–19, 2009.

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Abstract

Background

Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has recently been more frequently applied in thyroid surgery. However, concerns have been raised regarding the safety and optimal intensity of electrical nerve stimulation.

Methods

Eight piglets were enrolled, and electrically evoked electromyography (EMG) was recorded from the vocalis muscles via endotracheal surface electrodes. The baseline EMG was measured and continuous pulsatile stimulations were performed on the vagus nerve and RLN for 10 minutes. Changes of EMG waveform and cardiopulmonary status were analyzed.

Results

A dose–response curve existed with increasing EMG amplitude as stimulating current was increased, with maximum amplitude elicited on vagal and RLN stimulation at <1 mA. No obvious EMG changes and untoward cardiopulmonary effects were observed after the stimulation.

Conclusions

Electrical stimulation is safe during IONM in this porcine model. Minimal current that required generating the maximal evoked EMG, approximately 1 mA in this study, can be selected to minimize the risk of nerve damage and cardiopulmonary effects. © 2010 Wiley Periodicals, Inc. Head Neck, 2010

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Citing Literature

Volume32, Issue10

October 2010

Pages 1295-1301

Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model^†

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

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Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model†

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information

Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model^†