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Chen W, Chen Z, Cheng F, Wang Z, Li J, Li S, Xie H. The feasibility of the posterior tibial nerve-flexor hallucis brevis pathway applied in neuromuscular monitoring: a multicentric, controlled, and prospective clinical trial. PeerJ 2024; 12:e17154. [PMID: 38560472 PMCID: PMC10979752 DOI: 10.7717/peerj.17154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
This study aimed to investigate the clinical viability of utilizing the flexor hallucis brevis as an alternative site for neuromuscular monitoring compared to the conventional adductor pollicis. Patients were recruited from three medical centers. Cis-atracurium was administered, and two monitors were employed independently to assess neuromuscular blockade of the adductor pollicis and the ipsilateral flexor hallucis brevis, following a train of four (TOF) pattern until TOF ratios exceeded 0.9 or until the conclusion of surgery. Statistical analysis revealed significant differences in onset time, duration of no-twitch response, spontaneous recovery time, and total monitoring time between the two sites, with mean differences of -53.54 s, -2.49, 3.22, and 5.89 min, respectively (P < 0.001).The posterior tibial nerve-flexor hallucis brevis pathway presents a promising alternative for neuromuscular monitoring during anesthesia maintenance. Further investigation is warranted to explore its utility in anesthesia induction and recovery. Trial registration: The trial was registered at www.chictr.org.cn (20/11/2018, ChiCTR1800019651).
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Affiliation(s)
- Weiqiang Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhijian Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fang Cheng
- Department of Anesthesiology, Jiangmen Central Hospital, Jiangmen, China
| | - Zhuodan Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Juan Li
- GCP ClinPlus Co., Ltd, Guangzhou, China
| | - Shangrong Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hanbin Xie
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Oh SK, Lim BG, Kim H, Lee JH, Lee JE. Performance of a new auxiliary device based on wrist brace to improve accuracy and feasibility in neuromuscular monitoring with acceleromyography in prone-positioned patients undergoing lumbar spine surgery: a prospective randomized clinical trial. J Clin Monit Comput 2023:10.1007/s10877-023-01000-w. [PMID: 37004664 DOI: 10.1007/s10877-023-01000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
Accuracy of acceleromyography (AMG) is not be comparable to that of mechanomyography or electromyography (EMG). In particular, the prone position may reduce the accuracy and feasibility of AMG. We developed a new device based on wrist brace to allow free thumb movement and fix the other parts of the hand and wrist. We aimed to test whether the brace applied to the AMG would increase precision of AMG and agreement with the EMG in the prone position. Fifty-seven patients, undergoing lumbar surgery under general anesthesia, were randomly assigned to groups to which AMG was applied with or without (no) brace (29 in group B vs. 28 in group NB). EMG was performed in the contralateral arm. Repeatability coefficients of the first twitch height (T1) and train-of-four (TOF) ratio were assessed from nine consecutive measurements during spontaneous recovery from rocuronium-induced neuromuscular block and the AMGs of the two groups were compared in prone position. The agreement between AMG and EMG in each group was assessed using the Bland-Altman method. In group B, the repeatability coefficient of T1 was significantly lower during the recovery to T1 of 25% and TOF ratio of 0.9 (P = 0.017 and 0.033, respectively), indicating higher precision. The mean differences of bias (95% limits of agreement) between AMG and EMG in TOF ratio of 0.9 were 6.839 (- 26.54 to 40.22) in group NB and 3.922 (- 21.83 to 29.67) in group B. The wide limits of agreement in group NB was slightly narrowed in group B but without significance. Trial registration: registered on the UMIN Clinical Trials Registry in August 2020 (UMIN000041310).
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Affiliation(s)
- Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hak Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Eun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Assessment of the New Acceleromyograph TOF 3D Compared with the Established TOF Watch SX: Bland-Altman Analysis of the Precision and Limits of Agreement between Both Devices-A Randomized Clinical Comparison. J Clin Med 2022; 11:jcm11154583. [PMID: 35956198 PMCID: PMC9369732 DOI: 10.3390/jcm11154583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
The new acceleromyograph TOF 3D was compared with the established TOF Watch SX in patients undergoing elective laparoscopic gynecological surgery. Neuromuscular transmission was assessed by simultaneous recording with both devices. Measurements were performed simultaneously at the left and the right M. adductor pollicis (Group A, 25 patients), or the M. corrugator supercilii (Group CS, 25 patients). The repeatability, time course, and limits of agreement (Bland-Altman) were compared. The primary endpoint was the 90% train-of-four recovery time (TOFR 0.9). Other endpoints included onset time of block, maximum T1 depression, time to 25% T1 recovery, the recovery time course of T1 response, and TOF ratio, respectively. In group CS, the repeatability coefficient of the TOF 3D was lower (4.66 (1.6)) than of the TOF Watch SX (6.02 (1.9); p = 0.026). In group A, the onset of the block was faster when measured by the TOF 3D (98.7 (30) s vs. 112.2 (36) s (mean (SD)); p = 0.032). In group A, time to recovery to a TOFR of 90% was measured earlier by the TOF 3D (bias −0.71 min, limits of agreement from −8.94 to +7.51 min). The TOF 3D provides adequate information with high precision and sensitivity. It is suitable even for measurement sites with small muscle contractions such as the M. corrugator supercilii.
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Putz L, Lovqvist L, Bachy V, Van der Vorst S, Jamart J, Dubois PE. Evaluation of the impact of deep neuromuscular blockade on surgical conditions for laryngeal microsurgery with High Frequency Jet Ventilation. A comparison with no block during intravenous general anesthesia with topical lidocaine. Am J Otolaryngol 2022; 43:103187. [PMID: 34536915 DOI: 10.1016/j.amjoto.2021.103187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/22/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Laryngeal transoral surgery classically requires a neuromuscular block (NMB) to facilitate tracheal intubation and to improve surgical conditions. However, the short duration of most procedures and the potential complications of residual NMB lead to consider a no block approach. The hypothesis that intravenous anesthesia (remifentanil and propofol infusions) without NMB but including glottis topical lidocaine anesthesia would allow clinically acceptable laryngeal exposure and good surgical conditions was tested in the specific context of procedures undergone with High Frequency Jet Ventilation (HFJV). STUDY DESIGN A prospective randomized clinical comparison. METHODS 66 consenting patients were planned to receive 0.6 mg·kg-1 rocuronium or saline at random. The outcome measurements included the time and conditions to complete suspended laryngoscopy, and the surgical conditions rated by the surgeon. Any vocal cord movement or coughing was recorded. Data were compared using a Wilcoxon rank-sum test for numerical variables and chi-square test for categorical ones. Treatment failure was defined as an impossible laryngoscopy or a grade 4 surgical field occurring at any time during surgery and was compared to its null theoretical value by a general z-test. An interim analysis after completion of 50% patients was performed using Pocock boundaries at 0.0294 significance levels. RESULTS A significant failure rate occurred in the non paralysed group (27%, p < 0.001). No coughing and no vocal cords movement occurred in the NMB group. Poorer surgical conditions were obtained without NMB (p = 0.011). CONCLUSION Inducing a deep NMB ensured improved conditions during direct laryngeal microsurgery with HFJV.
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Affiliation(s)
- Laurie Putz
- Université catholique de Louvain, CHU UCL Namur, Department of Anesthesiology, Avenue Dr G Thérasse 1, 5530 Yvoir, Belgium.
| | - Linda Lovqvist
- Université catholique de Louvain, CHU UCL Namur, Department of Anesthesiology, Avenue Dr G Thérasse 1, 5530 Yvoir, Belgium
| | - Vincent Bachy
- Université catholique de Louvain, CHU UCL Namur, Department of Oto-rhino-laryngology, Avenue Dr G Thérasse 1, 5530 Yvoir, Belgium
| | - Sébastien Van der Vorst
- Université catholique de Louvain, CHU UCL Namur, Department of Oto-rhino-laryngology, Avenue Dr G Thérasse 1, 5530 Yvoir, Belgium
| | - Jacques Jamart
- Université catholique de Louvain, CHU UCL Namur, Scientific Support Unit, Avenue Dr G Thérasse 1, 5530 Yvoir, Belgium
| | - Philippe E Dubois
- Université catholique de Louvain, CHU UCL Namur, Department of Anesthesiology, Avenue Dr G Thérasse 1, 5530 Yvoir, Belgium
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Weigel WA, Thilen SR. Neuromuscular Blockade Monitoring and Reversal: A Clinical and Pharmacoeconomic Update. Adv Anesth 2021; 39:169-188. [PMID: 34715973 DOI: 10.1016/j.aan.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Wade A Weigel
- Department of Anesthesiology, Virginia Mason Franciscan Health, mailstop B2-AN, 1100 9th Avenue, Seattle, WA 98101, USA.
| | - Stephan R Thilen
- Anesthesiology & Pain Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
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Abstract
Neuromuscular monitoring is essential for optimal management of neuromuscular blocking drugs. Postoperative residual neuromuscular blockade continues to occur with an unacceptably high incidence and is associated with adverse patient outcomes. Use of a peripheral nerve stimulator and subjective tactile or visual assessment is useful for intraoperative management of neuromuscular blockade, especially when the patient's hand is accessible. Quantitative monitoring is necessary for confirmation of adequate reversal and for identification of patients who have recovered spontaneously and therefore should not receive pharmacologic reversal agents. Guidelines, as well as more user-friendly monitoring equipment, have created momentum toward improving routine perioperative neuromuscular monitoring.
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Affiliation(s)
- Stephan R Thilen
- Department of Anesthesiology & Pain Medicine, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA 98104, USA.
| | - Wade A Weigel
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA
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Dubois PE, Mitchell J, Regnier M, Passeraub PA, Moreillon F, d'Hollander AA. The interest of 100 versus 200 Hz tetanic stimulations to quantify low levels of residual neuromuscular blockade with mechanomyography: a pilot study. J Clin Monit Comput 2021; 36:1131-1137. [PMID: 34302578 DOI: 10.1007/s10877-021-00745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
A more sensitive method than the train-of-four ratio seems required to detect low levels of residual neuromuscular blockade before tracheal extubation. The goal of the study was to determine the potential benefit of 5 s of 100 versus 200 Hz tetanic stimulation to quantify the residual block with mechanomyography in anesthetised patients. Twenty informed and consenting 18- to 80-year-old patients undergoing nose surgery were included. On the left hand, neuromuscular transmission was continuously monitored by acceleromyography. On the right side, a new mecanomyographic device (Isometric Thumb Force©) recorded the force of thumb adduction (N) developed during 5 s of 100- and 200 Hz tetanic stimulations of the ulnar nerve at three consecutive times: baseline before inducing the neuromuscular blockade, at the time of contralateral train-of-four ratio 0.9 recovery, and 3 min after additional sugammadex reversal. Tetanic Fade Ratios (TFR = F residual/F max) were compared between 100 and 200 Hz stimulations using Student's t test. At the time of TOF ratio 0.9 recovery, both 100 and 200 Hz TFR were significantly decreased compared to baseline (0.61 and 0.16 on average, respectively, p < 0.0001). The 200 Hz TFR was significantly lower than the 100 Hz TFR (p < 0.0001). There were no differences between baseline and post-reversal TFR. The 200 Hz TFR has the potential to better describe low levels of residual neuromuscular blockade than the TOF ratio and 100 Hz TFR and would benefit from further investigations. Retrospectively registered in the Australian and New Zealand Clinical Trials Registry ACTRN12619000273189.
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Affiliation(s)
- Philippe E Dubois
- Université catholique de Louvain, CHU UcL Namur, Site Godinne, Avenue Dr G. Therasse, 1, 5530, Yvoir, Belgium.
| | - John Mitchell
- Université catholique de Louvain, CHU UcL Namur, Site Godinne, Avenue Dr G. Therasse, 1, 5530, Yvoir, Belgium
| | - Maxime Regnier
- Université catholique de Louvain, CHU UcL Namur, Site Godinne, Avenue Dr G. Therasse, 1, 5530, Yvoir, Belgium
| | - Philippe A Passeraub
- Laboratory of Microengineering and Bioinstrumentation, HEPIA - University of Applied Sciences Western Switzerland (HES-SO Geneva), Geneva, Switzerland
| | - Fabien Moreillon
- Laboratory of Microengineering and Bioinstrumentation, HEPIA - University of Applied Sciences Western Switzerland (HES-SO Geneva), Geneva, Switzerland
| | - Alain A d'Hollander
- Laboratory of Microengineering and Bioinstrumentation, HEPIA - University of Applied Sciences Western Switzerland (HES-SO Geneva), Geneva, Switzerland
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Philips Intellivue NMT module: precision and performance improvements to meet the clinical requirements of neuromuscular block management. J Clin Monit Comput 2019; 34:111-116. [DOI: 10.1007/s10877-019-00287-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/15/2019] [Indexed: 12/19/2022]
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Sakai D, Romano M, Tseng C, Flanders A, Martin-Flores M. Bias, limits of agreement, and percent errors between acceleromyography and mechanomyography in anesthetized dogs. Vet J 2018; 233:3-7. [DOI: 10.1016/j.tvjl.2017.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
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Philips Intellivue NMT module: variability of initial measurements. J Clin Monit Comput 2017; 32:965-966. [DOI: 10.1007/s10877-017-0079-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/11/2017] [Indexed: 11/25/2022]
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Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia 2017; 72 Suppl 1:16-37. [DOI: 10.1111/anae.13738] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Affiliation(s)
- M. Naguib
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Department of General Anesthesia; Cleveland Clinic; Cleveland Ohio USA
| | - S. J. Brull
- Department of Anesthesiology; Mayo Clinic College of Medicine; Jacksonville Florida USA
| | - K. B. Johnson
- Department of Anesthesiology; University of Utah; Salt Lake City Utah USA
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Varrique RM, Lauretti GR, Matsumoto JA, Lanchote VL, de Moraes NV. Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery. J Pharm Pharmacol 2016; 68:1351-1358. [DOI: 10.1111/jphp.12617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/10/2016] [Indexed: 12/20/2022]
Abstract
Abstract
Objective
To evaluate the impact of advanced age on rocuronium kinetic disposition in ASA I–III patients undergoing elective surgeries.
Methods
Young adult (20–50 years, n = 15) and elderly patients (65–85 years, n = 14) submitted to surgery under general anaesthesia were investigated. All patients were induced with individual intravenous doses of midazolam, rocuronium, fentanyl and propofol. Rocuronium-induced neuromuscular block was monitored by train of four stimulations of the adductor muscle of the thumb on the ulnar nerve. The pharmacokinetic parameters were calculated by non-compartmental analysis. The relationship between rocuronium plasma concentration and the neuromuscular blockade was described by a sigmoidal Emax model.
Key-findings
Elderly patients presented decreased Cl (2.1 ml/kg per min vs 2.8 ml/kg per min; P = 0.0123); increased AUC/dose (507.8 μg min/ml (mg/kg) vs 392.2 μg min/ml/(mg/kg); P = 0.0168) and reduced volume of distribution (285.4 ml/kg vs 435.6 ml/kg, P = 0.0434) compared to young adults. The concentrations required to achieve 50% of maximum neuromuscular block (EC50) were similar for young adult (338.8 ng/ml) and elderly (462.7 ng/ml) patients (P > 0.05).
Conclusions
Elderly patients showed increased AUC/D and reduced total Cl compared to young adult patients due to the age-related reduced renal function. Differences in the PK-PD properties of rocuronium in elderly population are due to changes in drug disposition rather than to alterations in the sensitivity to the drug.
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Affiliation(s)
- Renan M Varrique
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, USP – Univ. de São Paulo, Ribeirão Preto, Brazil
| | - Gabriela R Lauretti
- Faculdade de Medicina de Ribeirão Preto, USP – Univ. de São Paulo, Ribeirão Preto, Brazil
| | - Julia A Matsumoto
- Faculdade de Ciências Farmacêuticas, UNESP – Univ. Estadual Paulista, Araraquara, Brazil
| | - Vera L Lanchote
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, USP – Univ. de São Paulo, Ribeirão Preto, Brazil
| | - Natalia V de Moraes
- Faculdade de Ciências Farmacêuticas, UNESP – Univ. Estadual Paulista, Araraquara, Brazil
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Ross Renew J, Brull SJ. The Effect of Quantitative Neuromuscular Monitoring on the Incidence of Residual Neuromuscular Blockade and Clinical Outcomes. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Soltesz S, Stark C, Noé KG, Anapolski M, Mencke T. Monitoring recovery from rocuronium-induced neuromuscular block using acceleromyography at the trapezius versus the adductor pollicis muscle: an observational trial. Can J Anaesth 2016; 63:709-17. [PMID: 26864194 DOI: 10.1007/s12630-016-0609-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 01/14/2016] [Accepted: 02/02/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Positioning for surgery can restrict access to the patient's hand, thereby limiting assessment of the response at the adductor pollicis muscle to ulnar nerve stimulation. We evaluated a novel site to assess neuromuscular block by stimulating the accessory nerve and measuring the acceleromyographic response at the trapezius muscle. METHODS In this prospective non-blinded observational study, we assessed neuromuscular transmission in anesthetized adult female patients undergoing elective laparoscopic gynecological surgery. We performed the assessment by simultaneous recording acceleromyographic responses with the TOF-Watch(®) SX monitor at both the right adductor pollicis and left trapezius muscles. The neuromuscular block was achieved using rocuronium 0.3 mg·kg(-1), and the repeatability, time course, and limits of agreement (Bland-Altman) of responses were compared at the two recording sites. The primary endpoint was the 90% train-of-four (TOF) recovery time with other endpoints included the onset time of the block, maximum T1 depression, time to 25% T1 recovery, and recovery time course of the T1 response and TOF ratio. RESULTS Thirty-six patients were enrolled with responses obtained from 27 subjects. The variability of baseline responses recorded at the trapezius muscle was larger than that recorded at the adductor pollicis muscle, as determined by their mean (SD) repeatability coefficients [twitch height T1, 6.1 (1.9)% and 4.2 (1.6)%, respectively; P = 0.001; TOF ratio, 6.2 (2.1)% and 4.3 (1.7)%, respectively; P = 0.001]. The recorded responses showed relatively narrow limits of agreement. The onset time of the block was 0.3 min earlier at the trapezius muscle than at the adductor pollicis muscle [2.3 (0.8) min and 2.6 (0.7) min, respectively; P = 0.007], with limits of agreement ranging from 1.6 min earlier to 1.0 min later. The time to 25% T1 recovery was 1.8 min earlier at the trapezius muscle than at the adductor pollicis muscle [18.2 (5.7) min and 20.0 (5.2) min, respectively; P = 0.039], with limits of agreement ranging from 11.1 min earlier to 7.5 min later. Additionally, the time to achieve 90% TOF ratio was 4.4 min earlier at the trapezius muscle than at the adductor pollicis muscle [32.6 (7.9) min and 37 (9.1) min, respectively; P = 0.004], with limits of agreement ranging from 18.4 min earlier to 9.7 min later. CONCLUSIONS We conclude that recording evoked acceleromyographic responses at the trapezius muscle is an acceptable alternative when monitoring from the adductor pollicis muscle is compromised. Nevertheless, we caution that recording a 90% TOF response at the trapezius muscle may overestimate functional recovery from the neuromuscular blockade. This trial was registered at ClinicalTrials.gov identifier, NCT01849198.
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Affiliation(s)
- Stefan Soltesz
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, 41540, Dormagen, Germany.
| | - Christian Stark
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, 41540, Dormagen, Germany
| | - Karl G Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany
| | | | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany
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Fuchs-Buder T. Residual neuromuscular blockade and postoperative pulmonary outcome. Eur J Anaesthesiol 2014; 31:401-3. [DOI: 10.1097/eja.0000000000000065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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