Sung Eui-Suk, Shin Sung-Chan, Kwon Hyun-Keun, Kim Jia, Park Da-Hee, Choi Seong-Wook, Kim Sang-Hoon, Lee Jin-Choon, Ro Jung-Hoon, Lee Byung-Joo
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Clin Exp Otorhinolaryngol. 2020 Aug;13(3):291-298. doi: 10.21053/ceo.2019.01249. Epub 2020 Jul 17.
The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model.
We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared.
No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery.
The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.
在甲状腺切除术中使用肌电图（EMG）进行术中神经监测（IONM）时信号丢失是最大的问题之一。我们开发了一种新型的IONM系统，该系统使用带有附加压力传感器的气管内导管（ETT）代替EMG来检测喉部抽搐。本研究的目的是在猪模型的甲状腺切除术中研究这种带有压力传感器的新型ETT的IONM系统的可行性和可靠性。
我们开发了一种带有压力传感器的ETT，该传感器利用压电效应来测量喉部肌肉抽搐。将使用压力传感器评估的喉部抽搐的刺激阈值、幅度和潜伏期与使用经软骨针肌电图测量的结果进行比较。比较了喉返神经（RLN）牵引损伤期间EMG和压力传感器测量的幅度变化。
未观察到EMG和压力传感器之间的刺激阈值强度有显著差异。在0.3 mA时检测到的EMG幅度随刺激强度的增加而增加。当刺激超过1.0 mA时，幅度显示出平稳状态。在RLN牵引损伤实验中，即使在停止RLN牵引20分钟后，EMG幅度仍未恢复。然而，压力传感器大多显示恢复。
压力传感器刺激引起的幅度变化显示出与EMG相似的模式。压力传感器可通过检测喉部肌肉抽搐，切实可靠地用于RLN牵引损伤预测、RLN识别和保护。我们使用带有附加压力传感器的ETT来测量表面压力变化的新型IONM系统未来可能成为EMG的替代品。
