• Che-Wei Wu, I-Cheng Lu, Gregory W Randolph, Wen-Rei Kuo, Ka-Wo Lee, Chang-Lin Chen, and Feng-Yu Chiang.
• Department of Otolaryngology, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
• Head Neck. 2010 Oct 1; 32 (10): 1295-301.

BackgroundIntraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has recently been more frequently applied in thyroid surgery. However, concerns have been raised regarding the safety and optimal intensity of electrical nerve stimulation.MethodsEight piglets were enrolled, and electrically evoked electromyography (EMG) was recorded from the vocalis muscles via endotracheal surface electrodes. The baseline EMG was measured and continuous pulsatile stimulations were performed on the vagus nerve and RLN for 10 minutes. Changes of EMG waveform and cardiopulmonary status were analyzed.ResultsA dose-response curve existed with increasing EMG amplitude as stimulating current was increased, with maximum amplitude elicited on vagal and RLN stimulation at <1 mA. No obvious EMG changes and untoward cardiopulmonary effects were observed after the stimulation.ConclusionsElectrical stimulation is safe during IONM in this porcine model. Minimal current that required generating the maximal evoked EMG, approximately 1 mA in this study, can be selected to minimize the risk of nerve damage and cardiopulmonary effects.© 2010 Wiley Periodicals, Inc.

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