intraoperative laryngeal electromyography (lemg) in children with
TRANSCRIPT
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Intraoperative Laryngeal Electromyography (LEMG) in
Children with Vocal Fold Immobility: A Longitudinal Study
LEMG Setup Guide
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LEMG Setup Goal
• Capture EMG readings with audio from NIM and transfer to digital format that can be read by study neurologist
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LEMG Setup
• Basic required equipment– Medtronic NIM Response 2.0 w/ VGA and
audio output– Video Converter (VGA to S-Video or
composite video)– Audio cable– Digital recording device (PC with video
recording software and CD/DVD burner)
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LEMG Setup(What you need to buy…)
• Most ORs will need to buy a video converter– Any unit that will convert VGA output to S-video or
composite video will suffice• The current model of the unit used at MEEI is
available from:– Focus Enhancements Inc, Campbell, CA
(http://www.focusinfo.com/solutions/catalog.asp?id=151)
• TView Micro (part #:444-8600) $89 (requires USB port as power source)
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Simplified LEMG Technique -MEEI Method
• Equipment– Medtronic NIM Response 2.0
• Must have VGA and audio output– Video converter (TView MicroXGA, Focus
Enhancements Inc, Campbell, CA)• Convert NIM output from VGA to S-video
or RCA to allow connection to digital video recorder
– Digital video recorder (Med X Change DRS2, Med X Change, Inc, Bradenton, FL)• Can use any PC with video input card, video
recording software and CD/DVD burner– Paired subdermal electrodes (Medtronic
PN#8227410)
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ConnectionsNIM
Response 2.0 Unit
VGA Video Converter
Video Recorder / PC
VGA video cable
S-video or composite video cable
Audio cable
Produces CD/DVD
NIM interface box(small white box to plug leads into)
Paired subdermalleads
White NIM interface cable
Ground lead
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NIM interface box connectionsPaired subdermal
electrodes (to patient’s larynx) Grounding lead
(to patient’s chest or
shoulder)
NIM interface cable
(to NIM machine)
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NIM connections (without wires)
VGA Video Out
RCA Audio Out
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NIM Connections(with wires in place)
VGA video cable
(to video converter)
RCA audio cable
(to video recorder)
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Video converter connections
VGA video in
S-Video Out
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Video converter connections(top view of the same)
VGA video in (from NIM)
S-Video out (to video recorder)
AC power in (from wall plug)
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Video recorder / PC connectionS-Video in (from video converter)
RCA audio in (from NIM)
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LEMG Setup
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Preop NIM Setup
• Turn on machine– Quick setup screen
• Press “New”– This creates a new
profile
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Preop NIM Setup
• Default screen appears
• Press “Left Vocalis” to assign lead 1 (blue)
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Preop NIM Setup
• Press “Right Vocalis” to assign lead 2 (red)
• Press OK
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Preop NIM Setup
• Type “LEMG”as setup name
• Press OK
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Preop NIM Setup
• Press “Audio” to ensure audio is enabled
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Preop NIM Setup
• Under “Tones”– ensure that “EMG
audio” and “Event Tones” are checked
• Then press “Display” to change amplitude settings
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Preop NIM Setup
• Under “EMG Scales”– ensure that “Show
on main display” is checked
• Set amplitude to “50 µV”
• Set time to “50 mS”• Then press “Save”
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Preop NIM Setup
• Press “LEMG” to get started
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Preop NIM Setup
• Press “EMG” in top left corner to view EMG tracings started
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Preop NIM Setup
• Ensure that time scale and amplitude are set at 50ms and 50 µV respectively
• Warning box will display until leads are placed
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Intraop
• Place child into laryngeal suspension• Place subcutaneous grounding lead (green)
into chest/shoulder• Place electrodes into vocalis using alligator
forceps– Into belly of muscle without passing through
vocal fold– Blue into LEFT, Red into RIGHT
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Intraop
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Intraop
• EMG tracings are visible on NIM
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Intraop
• Video recording on PC starts during emergence from anesthesia
• Electrodes are left in place until child is awake and tracings recorded– Gently pulled out at end of procedure
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Special consideration
• If size of larynx or exposure precludes placing both leads simultaneously, may proceed with one side at a time. – Place lead and record during emergence
from anesthesia– Deepen anesthesia again and repeat on
the opposite side• Ensure that both recordings are
recorded and sent