Users Online: 208 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2019  |  Volume : 35  |  Issue : 1  |  Page : 132-135

Selection of laryngeal electrodes for intraoperative laryngeal nerve monitoring


Department of Paediatric Anaesthesia, KK Women and Children's Hospital 100 Bukit Timah Road, Sinagpore 229899, Adjunct Assist Professor Dukes NUS Medical School 8 College Road, 169857, Singapore

Date of Web Publication16-Apr-2019

Correspondence Address:
Hwan Ing Hee
Department of Paediatric Anaesthesia, KK Women and Children's Hospital 100 Bukit Timah Road, Sinagpore 229899, Adjunct Assist Professor Dukes NUS Medical School 8 College Road, 169857
Singapore
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_138_18

Rights and Permissions

How to cite this article:
Hee HI. Selection of laryngeal electrodes for intraoperative laryngeal nerve monitoring. J Anaesthesiol Clin Pharmacol 2019;35:132-5

How to cite this URL:
Hee HI. Selection of laryngeal electrodes for intraoperative laryngeal nerve monitoring. J Anaesthesiol Clin Pharmacol [serial online] 2019 [cited 2019 Jul 20];35:132-5. Available from: http://www.joacp.org/text.asp?2019/35/1/132/256387



Madam,

Neurophysiological monitoring for localization of the laryngeal nerve is achieved through surface contact between laryngeal muscles and specialized laryngeal electrode. These electrodes are commercially available as disposable surface adhesives or embedded within an electromyograph (EMG) tracheal tube. Besides understanding the structure and function,[1] it is prudent for anesthesiologists to be cognizant of commercially available options to allow discerning selection for the best fit that is essential for its function [Table 1]. Electrode embedded EMG tracheal tubes are commercially available in sizes from 6 to 9 mm internal diameter (I.D.). Compared to the earlier Medtronic Xomed tracheal tube, the newer TriVantage tracheal tube has a smaller outer diameter that is comparable with standard tracheal tubes. Its possible availability in 5 mm I.D. further improves its suitability for smaller adults and children. However, lack of ½ sizes with EMG tubes remains a major shortcoming for paediatric use. The other option is commercial surface laryngeal electrode adhesives which are available in sizes that fit tracheal tube ranging from 4 to 10 mm I.D, enabling utility in younger or smaller patients. These electrodes are designed to adhere onto preselected tracheal tubes of specified I.D. as recommended by manufacturers. To optimize the fit with the true vocal cords to allow detection of bilateral laryngeal responses, selected tracheal tube are prepared by adhering the surface adhesives to the tube at appropriate shaft position. Compared to the typical flush design of other laryngeal electrodes, the newer bulb design of Neurosign's lantern laryngeal electrode has the advantage of ensuring contact with the vocal cords even if tracheal tube position is suboptimal. Adhesion of contact electrodes onto the tracheal tube shaft nevertheless increases the rigidity and adds to its overall outer diameter. For children, the wider selection of commercial brands and sizes makes adhesive electrodes a feasible option though there is still lack of adhesive electrodes fitting tracheal tube sizes smaller than 4-mm I.D. When larger electrode than recommended is used, care must be taken to minimize overlapping of electrodes for proper functioning.
Table 1: Types of laryngeal electrodes

Click here to view


Complications and Food and Drug Administration recall of EMG electrodes from market had been reported and are also summarized in [Table 1]. Reported complications of use of embedded EMG tracheal tubes included cuff perforation from dislocated or distorted electrodes during stylet-assisted intubation,[2] cuff herniation,[3] and tracheal tear.[4] Airway complication from electrode sheath malfunction has also been reported in locally prepared electromyography tube in paediatric use.[5]

As recurrent laryngeal nerve monitoring is still relatively new. Knowledge of available sizing of electrodes for the best fit and awareness of problem from user experience are another important practical consideration for selection of the most appropriate laryngeal electrodes

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Atlas G, Lee M. The neural integrity monitor electromyogram tracheal tube: Anesthetic considerations. J Anaesthesiol Clin Pharmacol 2013;29:403-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
de Kant-Pariama E, Preckel B, Schlack WS, van Dijkum EJ. Cuff perforation by dislocated electrodes of an electromyogram tube. Anesth Analg 2012;115:1473.  Back to cited text no. 2
    
3.
Oysu C, Demir K. Life-threatening complication of recurrent laryngeal nerve monitoring with EMG reinforced silicone ETT. J Craniofac Surg 2011;22:2419-21.  Back to cited text no. 3
    
4.
Joshi M, Mardakh S, Yarmush J, Kamath H, Schianodicola J, Mendoza E. Intraoperatively diagnosed tracheal tear after using an NIM EMG ETT with previously undiagnosed tracheomalacia. Case Rep Anesthesiol 2013;2013:568373.  Back to cited text no. 4
    
5.
McCormack J, Purdy R. Airway complication related to an electromyography tracheal tube. Paediatr Anaesth 2008;18:572-3.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Tables

 Article Access Statistics
    Viewed159    
    Printed3    
    Emailed0    
    PDF Downloaded33    
    Comments [Add]    

Recommend this journal