Electromyographic Endotracheal Intubation in Pig: A Technique to Insert Electromyographic Tube Inside the Pig Trachea

Abstract

Source: Wu, C. W., et al. Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model. J. Vis. Exp. (144) (2019).

This video demonstrates a procedure to insert an electromyography tube inside the pig's trachea. It helps to keep the pig ventilated and monitor the electrical activity of laryngeal muscles in real-time.

Protocol

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Tracheal intubation (Figure 1B)

1. Prepare the equipment and materials required for electromyography (EMG) tube intubation: a size #6 EMG endotracheal tube, a face mask for assisted ventilation, two slings to hold the mouth open, one gauze strip to pull the tongue, a blunt tip suction catheter, a veterinary laryngoscope with 20cm straight blades, an elastic bougie, a 20-mL syringe, a stethoscope, and adhesive tape.
2. Position the anesthetized piglet in a prone position on the op....

Results

Figure 1. Preparation and anesthesia of KHAPS Black/Duroc-Landrace Pigs for IONM research. (A) Net weight of each piglet was measured before anesthesia. (B) An assistant maintained an adequate mouth opening while traction was .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Criticare systems	nGenuity	8100E	physiologic monitoring, including capnography, electrocardiography (ECG) and monitoring of oxygenation (SaO2)
Intraoperative NIM nerve monitoring systems	Medtronic	NIM-Response 3.0	monitor EMG activity from multiple muscles. If there is a change in nerve function, the NIM system may provide audible and visual warnings to help reduce the risk of nerve damage.
NIM TriVantage EMG Tube	Medtronic	8229706	6 mm ID, 8.2 mm OD. The NIM TriVantage EMG Tube is a standard size, non-reinforced, DEHP-free PVC tube that features smooth, conductive silver ink electrodes and a cross-band to guide placement. It has reduced sensitivity to rotation and movement while offering increased EMG responses that facilitate improved nerve dissection.
NIM Contact Reinforced EMG Endotracheal Tube	Medtronic	8229506	6 mm ID, 9 mm OD. The NIM Contact EMG Tube continuously monitors electromyography (EMG) activity during surgery. An innovative design allows the tube to maintain contact, even upon rotation. Vocal cords are more easily visible against the white band. Recording electrode leads are twisted pair. Packaged sterile with one green and one white subdermal needle. Single use.
NIM Standard Reinforced EMG Endotracheal Tube	Medtronic	8229306	6 mm ID, 8.8 mm OD. The NIM Standard EMG Tube continuously monitors electromyography (EMG) activity during surgery. Recording electrode leads are twisted pair. Packaged sterile with one green and one white subdermal needle. Single use.
NIM Flex EMG Endotracheal Tube	Medtronic	8229960	6 mm. The NIM Flex EMG Tube monitors vocal cord and recurrent laryngeal nerve EMG activity during surgery. An updated, dual-channel design allows the tube to maintain contact with the vocal cords, even upon rotation. Recording electrode leads are twisted pair. Packaged sterile with one green and one white subdermal needle. Single use.
APS (Automatic Periodic Stimulation) Electrode*	Medtronic	8228052 / 8228053	2 mm/ 3mm. The APS Electrode offers continuous, real-time monitoring. The electrode is placed on the nerve and can provide early warning of a change in nerve function.
Neotrode ECG Electrodes	ConMed	1741C-003	The electrode is made of a clear tape material, which allows for continuous observation of the patient's skin during monitoring.