scholarly journals The Effect of Preload on Electromyographic Train-Of-Four Ratio at the First Dorsal Interosseous Muscle during Spontaneous Recovery from Neuromuscular Blockade

2018 ◽  
Vol 46 (6) ◽  
pp. 614-619
Author(s):  
A. Bansal ◽  
P. A. Stewart ◽  
S. Phillips ◽  
S. Liang ◽  
X. Wang
Keyword(s):  
Neuromuscular Blockade ◽  
Spontaneous Recovery ◽  
Repeated Measurements ◽  
First Dorsal Interosseous ◽  
Reversal Agent ◽  
Residual Neuromuscular Blockade ◽  
Train Of Four ◽  
First Dorsal Interosseous Muscle ◽  
Induction Of Anaesthesia ◽  
Dorsal Interosseous Muscle

Accurate and reliable quantitative neuromuscular function monitoring is desirable for the optimal management of neuromuscular blockade, selection of the most appropriate reversal agent and dosage, and assessing the completeness of reversal to exclude residual neuromuscular blockade. Applying preload to the thumb may affect the precision of electromyography. This study compared the precision and agreement of electromyography with and without preload during recovery from non-depolarising neuromuscular blockade. After induction of anaesthesia and before neuromuscular blockade, the supramaximal current required at the first dorsal interosseous muscle with and without preload was determined. During recovery, train-of-four ratios were recorded using electromyography every 20 seconds. Alternating pairs of measurements (with and without preload) were obtained until spontaneous recovery was achieved. The preload device applied a resting tension of 75–150 g to the thumb. Bland–Altman analysis for repeated measurements was used to assess precision and agreement of electromyography responses with and without muscle preload. Two hundred and seventy-five sets of repeated measurements were collected from 35 participants. The repeatability coefficient for train-of-four ratios recorded by electromyography with a preload was 0.030 (95% confidence intervals, CI, 0.028 to 0.031) versus 0.068 (95% CI 0.064 to 0.072) without. Train-of-four ratios with preload demonstrated a bias of +0.038 (95% CI 0.037 to 0.042) compared to electromyography without, with 95% limits of agreement of 0.035–0.111. Preload significantly improved the precision of electromyographic train-of-four ratios, with 95% of consecutive measurements differing by less than 3%. Furthermore, electromyography with preload demonstrated a positive bias of 0.04 compared with electromyography alone, the clinical significance of which requires further research.

scholarly journals Acceleromyography at the Flexor Hallucis Brevis Muscle Underestimates Residual Neuromuscular Blockade

2013 ◽  
Vol 7 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Yasuyuki Sugi ◽  
Keiichi Nitahara ◽  
Kiyoshi Katori ◽  
Go Kusumoto ◽  
Kenji Shigematsu ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Upper Limb ◽  
Lower Limb ◽  
Onset Time ◽  
Neuromuscular Function ◽  
Lower Limbs ◽  
First Dorsal Interosseous ◽  
Residual Neuromuscular Blockade ◽  
First Dorsal Interosseous Muscle ◽  
Dorsal Interosseous Muscle

Purpose: Recovery of the train-of-four ratio (TOFR) to > 0.9 in the upper limb is commonly used to determine that neuromuscular function has returned to the preoperative level. It is not known whether recovery of neuromuscular function can be determined in the same way using lower limb acceleromyography. We compared measurements of recovery from neuromuscular blockade using upper limb electromyography and lower limb acceleromyography. Methods: Twenty-nine patients who were scheduled for elective surgery were enrolled in this study. Patients were excluded if they had neuromuscular disease or contraindications to neuromuscular blockade. General anesthesia was induced and maintained with propofol and fentanyl. Patients were monitored using electromyography at the first dorsal interosseous muscle of the upper limb and acceleromyography at the flexor hallucis brevis muscle of the lower limb. Vecuronium 0.1 mg/kg was administered for neuromuscular blockade, and the profile of the blockade was recorded, including onset time and recovery times to TOFR 0.7 and 0.9. Results were compared between the upper and lower limbs. Results: The first dorsal interosseous muscle of the upper limb was slower to recover to TOFR 0.7 and 0.9 than the flexor hallucis brevis muscle. When the TOFR at the flexor hallucis brevis muscle had recovered to 0.9, the TOFR at the first dorsal interosseous muscle was 0.44 ± 0.23. Conclusion: Monitoring the flexor hallucis brevis muscle using acceleromyography underestimates the residual neuromuscular blockade.

Restoration of the first dorsal interosseous muscle

2021 ◽  
Author(s):  
C. Jaloux ◽  
A. Mayoly ◽  
C. Philandrianos ◽  
E. Bougie ◽  
R. Legré
Keyword(s):  
First Dorsal Interosseous ◽  
First Dorsal Interosseous Muscle ◽  
Dorsal Interosseous Muscle

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

2018 ◽  
Vol 129 (5) ◽  
pp. 880-888 ◽  
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.

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