Tiroid ameliyatı bir domuz modelinde intraoperatif sinir izleme
Summary
Bu çalışmada tiroid ameliyatı bir domuz modelinde intraoperatif sinir izleme standart bir protokol geliştirmeyi amaçlamaktadır. Burada, genel anestezi, farklı elektrot karşılaştırmak ve normal ve yaralı tekrarlayan gırtlak sinirlerin elektrofizyolojik özellikleri incelemek için göstermek için bir iletişim kuralı mevcut.
Abstract
Vokal kord paralizi, konuşma ile müdahale ve potansiyel olarak nefes ile etkileyebilir tekrarlayan gırtlak sinir (RLN) intraoperatif yaralanmalara neden olabilir. Son yıllarda, intraoperatif sinir (IONM) izleme RLN yerelleştirmek RLN yaralanma algılayıp vokal kord işlevi işlemleri sırasında tahmin etmek için ek bir teknik olarak yaygın olarak adapte edilmiş. Yeni uygulamalar IONM teknoloji araştırmak ve intraoperatif RLN yaralanma önlemek için güvenilir stratejileri geliştirmek için birçok çalışma hayvan modelleri de kullandık. Bu makalenin amacı IONM araştırmada bir domuz modeli kullanılarak standart protokol tanıtmaktır. Makale genel anestezi, trakeal entübasyon ve RLN yaralanmalar elektrofizyolojik özelliklerini araştırmak için deneysel tasarım inducing yordamları gösterir. Bu protokol uygulamaları 3R ilke (değiştirme, azaltma ve arıtma) uygulanmasında genel etkinlik domuz IONM çalışmalarda artırabilirsiniz.
Introduction
Zamandan Şimdi sık gerçekleştirilen yordam dünya çapında olsa da, ameliyat sonrası ses disfonksiyon hala yaygındır. Vokal kord paralizi, konuşma ile müdahale ve potansiyel olarak nefes ile etkileyebilir tekrarlayan gırtlak sinir (RLN) intraoperatif yaralanmalara neden olabilir. Ayrıca, yaralanma üstün gırtlak sinir dış dalı zift ve vokal projeksiyon etkileyen bir büyük ses değişikliği neden olabilir.
İntraoperatif sinir (IONM) tiroid işlemleri sırasında izleme eşleme ve RLN, vagus siniri (VN) ve üstün gırtlak sinir (EBSLN) dış Şubesi teyit için yardımcı bir teknik olarak geniş popülerlik elde etti. Çünkü IONM teyit ve mekanizmaları RLN yaralanma ve anatomik varyasyonları RLN içinde algılamak için elucidating için yararlıdır, vokal kord işlevi zamandan sonra tahmin etmek için kullanılabilir. Bu nedenle, IONM tiroid cerrahisinde yeni fonksiyonel dinamik ekler ve cerrahlar doğrudan görselleştirme yalnız1,2,3,4,5 tarafından alınan bilgilerle güçlendiriyor , 6 , 7 , 8 , 9 , 10.
Son zamanlarda, birçok potansiyel çalışma domuz modelleri IONM teknoloji kullanımını optimize etmek ve intraoperatif RLN yaralanma11,12,13,14 önlemek için güvenilir stratejileri kurmak için kullandık ,15,16,17,18,19,20. Domuz modelleri de temel eğitim ve eğitim IONM klinik uygulamalarında uygulayıcıları sağlamak amacıyla kullanılmaktadır.
Bu nedenle, hayvan modelleri ve IONM teknoloji ile birlikte RLN yaralanma21Patofizyoloji çalışmak için değerli bir araçtır. Bir domuz IONM araştırma modelinde kullanımını göstermek için bu makalenin amacı oldu. Özellikle, makaleyi genel anestezi ikna etmek, trakeal entübasyon yapmak ve soruşturma RLN yaralanma çeşitli elektrofizyolojik özellikleri için deneyler kurmak gösterilmiştir.
Protocol
Representative Results
Discussion
RLN ve EBSLN ortaya olabilir tiroid cerrahi ile neden morbidite önemli bir kaynak kalır. Yakın zamana kadar sinir yaralanma sadece travma doğrudan görselleştirme tarafından belirlenmiştir. IONM kullanımı artık daha fazla stimülasyon uygulamak ve hedef kas kasılması kayıt RLN fonksiyonel kimliği sağlar. Şu anda, ancak, her iki geleneksel zaman zaman oluşabilir ve sürekli IONM sistem yanlış pozitif ve yanlış negatif yorumlar bazı teknik kısıtlamalar bulunmaktadır. Bu nedenle, uygun hayvan modell…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Bu çalışmada hibe Kaohsiung Tıp Üniversitesi Hastanesi, Kaohsiung Tıp Üniversitesi (KMUH106-6R49) ve teknoloji (çoğu 106-2314-B-037-042-MY2.), Tayvan ve Bilim Bakanlığı tarafından desteklenmiştir
Materials
| 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. |
| Standard Prass Flush-Tip Monopolar Stimulator Probe | Medtronic | 8225101 | Tips and Handles. For locating and mapping cranial nerves in the surgical field, the single-use Standard Prass Monopolar Stimulating Probe features a flush 0.5 mm tip diameter. The probe is insulated to the tip to prevent current shunting. Individually sterile packaged. |
| Ball-Tip Monopolar Stimulator Probe | Medtronic | 8225275/ 8225276 | Tip and Handle, 1.0 mm/ 2.3mm. Featuring a flexible ball tip and flexible shaft, the single-use Ball-Tip Monopolar Stimulating Probe allows greater access to neural structures. The 1.0 mm tip diameter allows atraumatic contact to larger neural structures. The probe is insulated to the tip to prevent current shunting. Individually sterile packaged. |
| Yingling Flex Tip Monopolar Stimulator Probe | Medtronic | 8225251 | Tips and Handles. The highly flexible single-use Yingling Monopolar Stimulating Probe allows stimulation in areas outside the surgeon’s field of view. The platinum-iridium wire of the probe is fully insulated to the ball tip to prevent current shunting. Individually sterile packaged with one green subdermal electrode. |
| Prass Bipolar Stimulator Probe | Medtronic | 8225451 | The single-use Prass Bipolar Stimulating Probe features a slim, flexible tip that allows greater access to neural structures. The probe tip is 0.5 mm in distance between cathode and anode for minimal shunting. Individually sterile packaged. |
| Concentric Bipolar Stimulator Probe | Medtronic | 8225351 | The single-use Concentric Bipolar Stimulating Probe features a 360° contact area. Insulation is complete to the active tip; cables and handles are polarized. Individually sterile packaged. |
| Side-by-Side Bipolar Stimulator Probe | Medtronic | 8225401 | The single-use Side-by-Side Bipolar Stimulating Probe features probe tips that are 1.3 mm apart, allowing neural structures to be stimulated between the tips. Insulation is complete to the active tip; cables and handles are polarized. Individually sterile packaged. |
| 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. |
| LigaSure Small Jaw | Medtronic | LF1212 | A FDA-approved electrothermal bipolar vessel sealing system for surgery |
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