title: Experience with two types of electromyography monitoring electrodes during thyroid surgery.
abstract: OBJECTIVE
  To prevent damage to the recurrent laryngeal nerve during thyroid or parathyroid surgery, spontaneous and evoked electromyography (EMG) can be used to locate the recurrent laryngeal nerve or determine when the nerve is being disturbed. Two commercial electrodes have been introduced to receive laryngeal EMG. This study compares the clinical performance of the two electrodes.
  
  
  METHODS
  The Xomed-Treace endotracheal tube electrode (Xomed-Treace, Jacksonville, FL) and the RLN postcricoid laryngeal electrode (RLN Systems, Jefferson City, MO) were placed concomitantly in 11 patients during 14 surgical procedures.
  
  
  RESULTS
  The RLN electrode provided feedback as to placement by providing a heart-beat artifact. The RLN electrode was found to be both more sensitive and more electrically noisy. On stimulation, the Xomed tube electrode produced generally higher EMG amplitudes, perhaps because of the different muscles they monitor. In one case, the Xomed tube failed to provide-EMG responses. Only at low electrical stimulation intensities could left and right vocalis muscles be identified with the Xomed tube. A laryngologist was needed to place the RLN electrode, whereas the attending anesthesiologist was able to place the Xomed tube.
  
  
  CONCLUSIONS
  Both electrodes provided useful EMG information and helped confirm the location of the recurrent laryngeal nerve. Who will place the electrode, tumors extrinsic or intrinsic to the larynx, cost, and size requirements should be considered when choosing an electrode.
authors.affiliation: Department of Communication Sciences and Disorders, Howard University, Washington, DC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: R C
authors.initials: RC
authors.lastname: Pearlman
authors.forename: D A
authors.initials: DA
authors.lastname: Bianchi
authors.forename: K W
authors.initials: KW
authors.lastname: Hauck
mesh_terms: D004566:Electrodes; D004576:Electromyography / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007821:Laryngeal Muscles / Q000294:innervation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D016105:Parathyroidectomy; D061226:Recurrent Laryngeal Nerve Injuries; D013965:Thyroidectomy