"Novel method for confirming appropriate nerve integrity monitor (NIM) endotracheal tube positioning".

Surgical injury to the recurrent laryngeal nerve (RLN) is a significant complication of head and neck surgery due to the potential for significant, permanent functional disability. Originally recommended by Lahey in 1938, intraoperative identification and protection of the nerve, remains the gold standard for minimizing RLN injury. Over time however, less invasive mechanisms for monitoring and protecting the RLN during surgical procedures have been developed. One such method is the endotracheal Nerve Integrity Monitoring (NIM) system. Several techniques to determine accurate positioning of the NIMs device have been proposed, some are simpler, less invasive, and more accurate than others. This clinical prospective study of 176 patients showed a novel method to determine correct positioning of the NIM device using a train of four (TOF) electric stimulation. TOF electrical stimulation resulted in contraction of the musculature and vocal cords overlying the NIMs device. As such, it provided more accurate positioning of the NIM device compared to a commonly used Tap Test method, which taps the larynx, (p < 0.001). This minimally invasive and improved method to determine accurate positioning of the NIMs device could therefore potentially minimize the risk of RLN injury.