Changes in electromyographic amplitudes but not latencies occur with endotracheal tube malpositioning during intraoperative monitoring for thyroid surgery: Implications for guidelines

During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal (ET) tube migration can result in a decrease in vocalis electromyographic (EMG) amplitude without a concordant latency elevation during stimulation of the recurrent laryngeal nerve (RLN). Retrospective re...

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Published inThe Laryngoscope Vol. 127; no. 9; p. 2182
Main Authors Barber, Samuel R, Liddy, Whitney, Kyriazidis, Natalia, Cinquepalmi, Matteo, Lin, Brian M, Modi, Rahul, Patricio, Stephanie, Kamani, Dipti, Belotti, Carlo, Mahamad, Sadhana, Lawson, Bradley, Randolph, Gregory W
Format Journal Article
LanguageEnglish
Published United States 01.09.2017
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Abstract During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal (ET) tube migration can result in a decrease in vocalis electromyographic (EMG) amplitude without a concordant latency elevation during stimulation of the recurrent laryngeal nerve (RLN). Retrospective review. Data were reviewed retrospectively for thyroid and parathyroid surgery patients with IONM of the laryngeal nerves from January 2015 to December 2015. Recordings of vocalis EMG amplitudes and latencies with RLN stimulation were obtained with the neuromonitoring ET tube surface electrodes in optimal baseline position, with vertical displacement away from the vocalis, and with rotational change away from baseline. ET tube surface electrode EMG recordings were obtained with stimulation of seven left and three right RLNs in a total of 10 patients. Mean vocalis EMG amplitudes were reduced with vertical displacement 1 and 2 cm both inferior and superior to baseline and with rotational change (45° and 90° clockwise and counterclockwise, 180°), although amplitude change with 45° clockwise and 180° rotation did not meet statistical significance. Mean EMG latency values did not change significantly from baseline with either rotation or vertical displacement of the ET tube. An isolated decrease in EMG amplitude without concordant latency elevation should warrant re-evaluation of ET tube position during thyroid and parathyroid surgery and is in contrast to a combined event, with both EMG amplitude decrease and concordant latency increase, which is more suggestive of a true neuropraxic injury. 4. Laryngoscope, 127:2182-2188, 2017.
AbstractList During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal (ET) tube migration can result in a decrease in vocalis electromyographic (EMG) amplitude without a concordant latency elevation during stimulation of the recurrent laryngeal nerve (RLN). Retrospective review. Data were reviewed retrospectively for thyroid and parathyroid surgery patients with IONM of the laryngeal nerves from January 2015 to December 2015. Recordings of vocalis EMG amplitudes and latencies with RLN stimulation were obtained with the neuromonitoring ET tube surface electrodes in optimal baseline position, with vertical displacement away from the vocalis, and with rotational change away from baseline. ET tube surface electrode EMG recordings were obtained with stimulation of seven left and three right RLNs in a total of 10 patients. Mean vocalis EMG amplitudes were reduced with vertical displacement 1 and 2 cm both inferior and superior to baseline and with rotational change (45° and 90° clockwise and counterclockwise, 180°), although amplitude change with 45° clockwise and 180° rotation did not meet statistical significance. Mean EMG latency values did not change significantly from baseline with either rotation or vertical displacement of the ET tube. An isolated decrease in EMG amplitude without concordant latency elevation should warrant re-evaluation of ET tube position during thyroid and parathyroid surgery and is in contrast to a combined event, with both EMG amplitude decrease and concordant latency increase, which is more suggestive of a true neuropraxic injury. 4. Laryngoscope, 127:2182-2188, 2017.
Author Kamani, Dipti
Kyriazidis, Natalia
Modi, Rahul
Lin, Brian M
Liddy, Whitney
Lawson, Bradley
Cinquepalmi, Matteo
Mahamad, Sadhana
Patricio, Stephanie
Barber, Samuel R
Belotti, Carlo
Randolph, Gregory W
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  organization: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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  givenname: Gregory W
  surname: Randolph
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  organization: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Issue 9
Keywords Thyroid and parathyroid surgery
amplitude change
combined event
recurrent laryngeal nerve
electromyography
intraoperative neural monitoring
Language English
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Snippet During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal (ET) tube migration can result in a decrease in vocalis...
SourceID pubmed
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StartPage 2182
SubjectTerms Adult
Aged
Electromyography - methods
Electrophysiological Phenomena
Female
Foreign-Body Migration - etiology
Foreign-Body Migration - physiopathology
Humans
Intraoperative Neurophysiological Monitoring - methods
Intubation, Intratracheal - adverse effects
Intubation, Intratracheal - instrumentation
Intubation, Intratracheal - methods
Male
Middle Aged
Parathyroid Glands - surgery
Reaction Time
Recurrent Laryngeal Nerve - physiopathology
Recurrent Laryngeal Nerve - surgery
Retrospective Studies
Thyroid Gland - surgery
Young Adult
Title Changes in electromyographic amplitudes but not latencies occur with endotracheal tube malpositioning during intraoperative monitoring for thyroid surgery: Implications for guidelines
URI https://www.ncbi.nlm.nih.gov/pubmed/27861939
Volume 127
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