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Stimulating Multiple Respiratory Muscles With Intramuscular Permaloc Electrodes

Abstract Objective: To test the feasibility of implanting intramuscular electrodes (Permaloc, Synapse Biomedical Inc, Oberlin OH) with self-securing polypropylene anchors to stimulate upper-intercostal and abdominal muscles plus the diaphragm. Methods/Results: In 6 anesthetized dogs, 12 Permaloc electrodes were implanted in the 3 respiratory muscles (4 in each muscle group). Tidal volume with diaphragmatic stimulation was 310±38 mL (mean±SE); with upper intercostal stimulation, it was 68±18 mL; and with combined diaphragm intercostal stimulation, it was 438±78 mL. By study design, stimulation in the upper intercostal muscles was limited to not more than slight/moderate contraction of the serratus and latissimus muscles overlying the ribs. Abdominal muscle stimulation produced exhaled volumes of 38±20 mL (this stimulation was limited by the maximal output of the stimulator of 25 milliamperes). Combined diaphragm intercostal stimulation followed by abdominal muscle stimulation increased exhaled volumes from 312±31 mL to 486±58 mL (P = 0.024). Conclusions: Permaloc electrodes can be successfully implanted in upper intercostal and abdominal muscles in addition to the diaphragm. Combined diaphragm intercostal stimulation followed by abdominal muscle stimulation increased the exhaled volumes recorded with diaphragmatic stimulation alone. J Spinal Cord Med. Apr 2010; 33(2):135-143