title: Optimal depth of NIM EMG endotracheal tube for intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroidectomy.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Chung-Ho Hospital, Kaohsiung, Taiwan.
authors.forename: I-Chen
authors.initials: IC
authors.lastname: Lu
authors.forename: Koung-Shing
authors.initials: KS
authors.lastname: Chu
authors.forename: Cheng-Jing
authors.initials: CJ
authors.lastname: Tsai
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Wu
authors.forename: Wen-Rei
authors.initials: WR
authors.lastname: Kuo
authors.forename: Hsiu-Ya
authors.initials: HY
authors.lastname: Chen
authors.forename: Ka-Wo
authors.initials: KW
authors.lastname: Lee
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D004566:Electrodes; D004576:Electromyography / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D012009:Recurrent Laryngeal Nerve; D061226:Recurrent Laryngeal Nerve Injuries; D012044:Regression Analysis; D013965:Thyroidectomy