Recommendations for standards of monitoring during anaesthesia and recovery 2021: caveats regarding neuromuscular monitoring

A bedridden patient with empyema presented for thoracoscopic decortication. During the procedure, despite a post-tetanic count (PTC) of 0 via calibrated quantitative neuromuscular monitoring, persistent diaphragmatic movement impaired operating conditions, so rocuronium was re-dosed. After surgery, the patient had 0 PTC. Sugammadex was titrated to achieve baseline neuromuscular strength, monitoring the effect of each 200-mg dose. Ultimately, 1200 mg was required to achieve baseline strength. We describe monitor troubleshooting, considerations with unexpectedly deep neuromuscular blockade, the importance of routine quantitative neuromuscular monitoring, and one strategy for sugammadex reversal in patients with profound paralysis outside of the standard dosing guidelines.

Download Full-text

A Clinical Comparison of Atracurium and Vecuronium in Women Undergoing Laparoscopy

Anaesthesia and Intensive Care ◽

10.1177/0310057x8701500311 ◽

1987 ◽

Vol 15 (3) ◽

pp. 310-316 ◽

Cited By ~ 2

Author(s):

M. A. Raynes ◽

R. Chisholm ◽

D. F. Woolner ◽

J. M. Gibbs

Keyword(s):

Sinus Bradycardia ◽

Neuromuscular Block ◽

Randomised Trial ◽

Neuromuscular Monitoring ◽

Double Blind ◽

Duration Of Action ◽

Prospective Randomised Trial ◽

Clinical Comparison ◽

Intraoperative Hypotension ◽

Significant Difference

In a double blind, prospective, randomised trial in 30 women undergoing laparoscopy, atracurium and vecuronium were compared in equipotent (2 X ED95) doses. In the atracurium group, first twitch depression was significantly greater at one minute, and degree of fade significantly greater at one and two minutes, but thereafter neuromuscular monitoring showed no significant difference between the groups. Clinically there was no significant difference between the drugs. Mild intraoperative hypotension was equally common in both groups as was sinus bradycardia. Reversal and recovery were comparable in the two groups. Neostigmine was required in all patients and in three (one atracurium, two vecuronium) a second dose was administered on clinical grounds. Antagonism of the neuromuscular block is required with surgery of this duration despite the intermediate duration of action of the relaxant drugs.

Download Full-text

The Efficacy of Several Neuromuscular Monitoring Modes at the P6 Acupuncture Point in Preventing Postoperative Nausea and Vomiting

Anesthesia & Analgesia ◽

10.1213/ane.0b013e31820f819e ◽

2011 ◽

Vol 112 (4) ◽

pp. 819-823 ◽

Cited By ~ 27

Author(s):

Yong H. Kim ◽

Kyo S. Kim ◽

Hee J. Lee ◽

Jae C. Shim ◽

Sung W. Yoon

Keyword(s):

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Acupuncture Point ◽

Neuromuscular Monitoring ◽

Nausea And Vomiting

Download Full-text

Neuromuscular Monitoring

Miller's Anesthesia ◽

10.1016/b978-0-443-06959-8.00047-9 ◽

2010 ◽

pp. 1515-1531 ◽

Cited By ~ 3

Author(s):

Jørgen Viby-Mogensen

Keyword(s):

Neuromuscular Monitoring

Download Full-text

Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function

Anesthesiology ◽

10.1097/aln.0000000000002400 ◽

2018 ◽

Vol 129 (5) ◽

pp. 880-888 ◽

Cited By ~ 14

Author(s):

Glenn S. Murphy ◽

Joseph W. Szokol ◽

Michael J. Avram ◽

Steven B. Greenberg ◽

Torin D. Shear ◽

...

Keyword(s):

Neuromuscular Blockade ◽

Spontaneous Recovery ◽

Three Dimensional ◽

Tracheal Extubation ◽

Neuromuscular Function ◽

Neuromuscular Monitoring ◽

Limits Of Agreement ◽

Train Of Four ◽

Good Agreement

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyography device that measures movement of the thumb in multiple planes. The aim of this observational investigation was to assess the agreement between nonnormalized and normalized train-of-four values obtained with the TOF-Watch SX (Organon, Ireland) and those obtained with the TOFscan during recovery from neuromuscular blockade. Methods Twenty-five patients were administered rocuronium, and spontaneous recovery of neuromuscular blockade was allowed to occur. The TOFscan and TOF-Watch SX devices were applied to opposite arms. A preload was applied to the TOF-Watch SX, and calibration was performed before rocuronium administration. Both devices were activated, and train-of-four values were obtained every 15 s. Modified Bland–Altman analyses were conducted to compare train-of-four ratios measured with the TOFscan to those measured with the TOF-Watch SX (when train-of-four thresholds of 0.2 to 1.0 were achieved). Results Bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at nonnormalized train-of-four ratios between 0.2 and 1.0 were 0.021 and −0.100 to 0.141, respectively. When train-of-four measures with the TOF-Watch SX were normalized, bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at ratios between 0.2 and 1.0 were 0.015 and −0.097 to 0.126, respectively. Conclusions Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery.

Download Full-text