Electromyographic endotracheal tube placement during thyroid surgery in neuromonitoring of recurrent laryngeal nerve  Cheng-Jing Tsai, Kuang-Yi Tseng, Fu-Yuan Wang, I-Cheng Lu, Hsun-Mo Wang, Che-Wei Wu, Hui-Ching Chiang, Feng-Yu Chiang, 蔡承 靜, 曾光毅, 王富元, 盧奕丞, 王遜模, 吳哲維, 姜慧菁, 江豐裕  The Kaohsiung Journal of Medical Sciences  Volume 27, Issue 3, Pages 96-101 (March 2011) DOI: 10.1016/j.kjms.2010.08.002 Copyright © 2011 Elsevier Taiwan LLC Terms and Conditions

Figure 1. Three marks are routinely made on the posterior surface of the Medtronic Xomed nerve integrity monitor standard reinforced electromyographic endotracheal tube. The exposed electrodes on the blue segment of the tube are 30mm in length. The first transverse line is put 5mm lower than the upper margin of the exposed electrodes, and the second transverse line is 10mm distal to the first line. The vertical line (15mm from the first transverse line) was made on the posterior midline of the tube. The marks are very useful to ensure proper positioning of electrodes during laryngofiberoscopic examination. The Kaohsiung Journal of Medical Sciences 2011 27, 96-101DOI: (10.1016/j.kjms.2010.08.002) Copyright © 2011 Elsevier Taiwan LLC Terms and Conditions

Figure 2. In laryngofiberoscopic examination, the first transverse line was placed at the level of the inter-arytenoid bar, and the true vocal cord would be located at the middle of the exposed electrodes. The vertical line is useful and helpful not only to detect the rotation of the tube, but also to judge the depth of the tube if the tube depth is suspected to be too deep intraoperatively. White arrow indicates the midline of the posterior aspect of the tube. Black arrow indicates the first transverse line made on the tube. A=arytenoids, IAB=inter-arytenoid bar. The Kaohsiung Journal of Medical Sciences 2011 27, 96-101DOI: (10.1016/j.kjms.2010.08.002) Copyright © 2011 Elsevier Taiwan LLC Terms and Conditions

Figure 3. The holder provides good support and fixation of the EMG endotracheal tube and the circuit tubes. It is very useful to prevent tube rotation and upward or downward displacements during the operation. The Kaohsiung Journal of Medical Sciences 2011 27, 96-101DOI: (10.1016/j.kjms.2010.08.002) Copyright © 2011 Elsevier Taiwan LLC Terms and Conditions

Figure 4. The plots depict the range of the electromyographic endotracheal tube displacement in Groups I and II. The range of tube displacement after neck extension was from 16mm upward to 4mm downward in Group I and from 12mm upward to 5mm downward in Group II. The rate of tube displacement greater than 10mm was 12.7% in Group I and 3.6% in Group II. ETT = endotracheal tube. The Kaohsiung Journal of Medical Sciences 2011 27, 96-101DOI: (10.1016/j.kjms.2010.08.002) Copyright © 2011 Elsevier Taiwan LLC Terms and Conditions