Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model

Yi Chu Lin, Gianlorenzo Dionigi, Gregory W. Randolph, I. Cheng Lu, Pi Ying Chang, Shan Yin Tsai, Hoon Yub Kim, Hye Yoon Lee, Ralph P. Tufano, Hui Sun, Xiaoli Liu, Feng Yu Chiang, Che Wei Wu

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objectives/Hypothesis Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage. Study Design Prospective porcine model with continuous intraoperative neuromonitoring (CIONM). Methods Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration. Results In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40/45/50/55°C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5 ± 1.3 seconds) when the temperature was elevated to 60°C (n = 4). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60/70°C for 30/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60°C exposure showed slight EMG amplitude recovery (16%-35%) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM. Conclusion Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy-based devices during thyroid procedures.

Original languageEnglish
Pages (from-to)E283-E290
JournalLaryngoscope
Volume125
Issue number8
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Recurrent Laryngeal Nerve
Swine
Hot Temperature
Recurrent Laryngeal Nerve Injuries
Wounds and Injuries
Temperature
Thyroid Gland
Prospective Studies
Equipment and Supplies

Keywords

  • continuous intraoperative neuromonitoring
  • energy-based devices
  • nerve thermal injury
  • Recurrent laryngeal nerve
  • thyroid surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Lin, Y. C., Dionigi, G., Randolph, G. W., Lu, I. C., Chang, P. Y., Tsai, S. Y., ... Wu, C. W. (2015). Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. Laryngoscope, 125(8), E283-E290. https://doi.org/10.1002/lary.25362

Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. / Lin, Yi Chu; Dionigi, Gianlorenzo; Randolph, Gregory W.; Lu, I. Cheng; Chang, Pi Ying; Tsai, Shan Yin; Kim, Hoon Yub; Lee, Hye Yoon; Tufano, Ralph P.; Sun, Hui; Liu, Xiaoli; Chiang, Feng Yu; Wu, Che Wei.

In: Laryngoscope, Vol. 125, No. 8, 01.01.2015, p. E283-E290.

Research output: Contribution to journalArticle

Lin, YC, Dionigi, G, Randolph, GW, Lu, IC, Chang, PY, Tsai, SY, Kim, HY, Lee, HY, Tufano, RP, Sun, H, Liu, X, Chiang, FY & Wu, CW 2015, 'Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model', Laryngoscope, vol. 125, no. 8, pp. E283-E290. https://doi.org/10.1002/lary.25362
Lin, Yi Chu ; Dionigi, Gianlorenzo ; Randolph, Gregory W. ; Lu, I. Cheng ; Chang, Pi Ying ; Tsai, Shan Yin ; Kim, Hoon Yub ; Lee, Hye Yoon ; Tufano, Ralph P. ; Sun, Hui ; Liu, Xiaoli ; Chiang, Feng Yu ; Wu, Che Wei. / Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. In: Laryngoscope. 2015 ; Vol. 125, No. 8. pp. E283-E290.
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abstract = "Objectives/Hypothesis Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage. Study Design Prospective porcine model with continuous intraoperative neuromonitoring (CIONM). Methods Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration. Results In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40/45/50/55°C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5 ± 1.3 seconds) when the temperature was elevated to 60°C (n = 4). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60/70°C for 30/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60°C exposure showed slight EMG amplitude recovery (16{\%}-35{\%}) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM. Conclusion Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy-based devices during thyroid procedures.",
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AU - Dionigi, Gianlorenzo

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AU - Chang, Pi Ying

AU - Tsai, Shan Yin

AU - Kim, Hoon Yub

AU - Lee, Hye Yoon

AU - Tufano, Ralph P.

AU - Sun, Hui

AU - Liu, Xiaoli

AU - Chiang, Feng Yu

AU - Wu, Che Wei

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N2 - Objectives/Hypothesis Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage. Study Design Prospective porcine model with continuous intraoperative neuromonitoring (CIONM). Methods Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration. Results In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40/45/50/55°C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5 ± 1.3 seconds) when the temperature was elevated to 60°C (n = 4). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60/70°C for 30/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60°C exposure showed slight EMG amplitude recovery (16%-35%) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM. Conclusion Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy-based devices during thyroid procedures.

AB - Objectives/Hypothesis Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage. Study Design Prospective porcine model with continuous intraoperative neuromonitoring (CIONM). Methods Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration. Results In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40/45/50/55°C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5 ± 1.3 seconds) when the temperature was elevated to 60°C (n = 4). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60/70°C for 30/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60°C exposure showed slight EMG amplitude recovery (16%-35%) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM. Conclusion Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy-based devices during thyroid procedures.

KW - continuous intraoperative neuromonitoring

KW - energy-based devices

KW - nerve thermal injury

KW - Recurrent laryngeal nerve

KW - thyroid surgery

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