BACKGROUND:The commonly used acceleromyography (AMG)-based neuromuscular monitor TOF-Watch SX is no longer manufactured. Recently, a new portable electromyography (EMG)based neuromuscular monitor TetraGraph was introduced in clinical anesthesia. The aim of the study was to compare the responses obtained simultaneously from the abductor digiti minimi (ADM) muscle with TetraGraph and the adductor pollicis (AP) muscle with TOF-Watch SX during rocuronium-induced neuromuscular block. METHODS: Patients undergoing orthopedic surgery with general anesthesia were enrolled in this prospective, observational study. During total intravenous general anesthesia, train-of-four (TOF) responses following 0.9-mg•kg −1 rocuronium administration were monitored at the AP muscle with TOF-Watch SX and the ADM muscle with TetraGraph on the opposite arms. Sugammadex 2 mg•kg −1 was administered when both devices showed TOF counts (TOFCs) = 2. The primary outcome was time from rocuronium administration to first appearance of posttetanic count (PTC) response (first PTC). The secondary outcomes were baseline TOF ratios (TOFRs), onset time, time to first reappearance of TOFC = 1 (time to TOFC1), time to first reappearance of TOFC = 2 (time to TOFC2), and time from sugammadex administration to TOFR ≥0.9 with TetraGraph or to normalized TOFR ≥0.9 with TOF-Watch SX (recovery time). We used paired t test and Wilcoxon signed-rank test to analyze parametric and nonparametric data, respectively. P <.05 defined statistical significance. RESULTS: A total of 20 patients were analyzed. The baseline TOFRs were significantly higher with TOF-Watch SX than with vs 100 [98][99][100][101]; P = .0002). The time to first PTC (minutes) (31.7 ± 9.6 vs 41.1 ± 12.3; P < .001), time to TOFC1 (minutes) (48.0 ± 12.7 vs 58.8 ± 19.2; P < .001), time to TOFC2 (minutes) (56.2 ± 15.7 vs 74.2 ± 23.7; P < .001), and recovery time (seconds) (61.5 [32-148] vs 75.5 [94-102]); P = .043) were significantly faster with TOF-Watch SX than with TetraGraph. There were no significant differences in onset time. CONCLUSIONS: TOF-Watch SX overestimated recovery from rocuronium-induced neuromuscular block compared with TetraGraph.
Preanesthetic ultrasonography assessment of inferior vena cava diameter (IVCD) in the supine position (SP), left lateral tilt position (LLT), and with the left uterine displacement maneuver (LUD) in full‐term pregnant women: a randomized cross‐over design study.AimWe pre‐anesthetically measured IVCD using ultrasonography in the SP, LLT, and the LUD in full‐term pregnant women, using a cross‐over design, to evaluate the effectiveness of LLT and LUD on increasing IVCD, and the presence of inter‐individual differences among patients in the effect of posture on IVCD.MethodsTwenty‐two parturients scheduled for elective cesarean section under spinal anesthesia were recruited. All patients were sequentially placed in the SP, LLT, and with LUD before spinal anesthesia induction. Indices of IVCD, measured by subxiphoid ultrasonography, including maximum IVCD (IVCDmax), minimum IVCD (IVCDmin), and collapsibility index (CI) were recorded in each of the postures. Mean or median values of all measurements were compared among the postures.ResultsThe mean values of IVCDmax observed with both LLT and LUD were significantly larger than those in the SP, respectively (SP vs. LLT: p < 0.05, SP vs. LUD: p < 0.01), although there were no significant differences between IVCDmax with LLT and LUD. There were no significant differences in IVCDmin and CI between any of the postures. IVCDmax was highest with LUD in 11 patients (55%), in the LLT in seven patients (35%) and in the SP in two patients (10%).ConclusionsLLT and LUD might be equally effective in enlarging the narrowed IVCD as compared to SP. However, both LLT and LUD might not necessarily be appropriate treatments to relieve IVC compression in some cases.
Background The AF-201P, a new electromyography (EMG)-based neuromuscular monitor has been developed recently. The aim of this clinical study was to compare two ulnar nerve innervated muscles: the adductor pollicis (AP) muscle and the abductor digiti minimi (ADM) muscle during the recovery from rocuronium-induced neuromuscular block by using EMG AF-201P. Methods Twenty patients undergoing surgery with general anesthesia were enrolled in the study. During total intravenous general anesthesia, train-of-four (TOF) and post-tetanic counts (PTC) responses following 0.9 mg/kg rocuronium administration were concurrently monitored at the AP and the ADM muscles with EMG AF-201P on the opposite arms. At the end of the surgery, sugammadex 2 mg/kg was administered when TOF counts of 2 was observed at both muscles. The primary outcome of the study was time from administration of rocuronium to first appearance of PTC response (first PTC). The secondary outcomes of the study were time from administration of rocuronium to first reappearance of TOF response (first TOF), time from first PTC to first TOF (PTC-TOF time), time to reappearance of TOF counts of 2, and time from administration of sugammadex to TOF ratio ≥ 0.9. Agreement between the two muscles was assessed using the Bland-Altman analysis. Data are expressed as mean ± standard deviation. Results Nineteen patients were included in the analysis. Time for appearance of the first PTC was significantly faster at the ADM muscle than the AP muscle (32.4 ± 13.1min vs 24.4 ± 11.4min, p = 0.006). Interval time between the first PTC and the first TOF was significantly longer with the ADM muscle than the AP muscle (19.4 ± 7.3min vs 12.4 ± 10.6min, p = 0.019). There were no significant differences in time to TOF counts of 2 and sugammadex-facilitated recovery between the two muscles. Bland-Altman analyses showed acceptable ranges of bias and limits of agreement of the two muscles. Conclusions The ADM muscle showed a good agreement with the AP muscle during rocuronium-induced neuromuscular block but faster recovery of PTC response when using EMG. Trial registration : UMIN-CTR (Registration No. UMIN000044904). Registered 19 July 2021 -Retrospectively registered,
Separation of flavanonol, phenylcoumaran and flavonolignans in Silybum marianum was examined using high-speed countercurrent chromatography (HSCCC). In order to prepare analytical standards, a flavanonol of aromadendrin (87.4% purity, 7.8 mg), three phenylcoumarans of jatrointelignan D (84.5% purity, 13.2 mg), dehydrodiconiferyl alcohol (76.1% purity, 1.4 mg) and dihydrodehydrodiconiferyl alcohol (93.0% purity, 5.8 mg), and three flavonolignans of silybin (88.8% purity, 35.6 mg), silydianin (99.3% purity, 25.1 mg) and silychristin (96.9% purity, 12.6 mg) were separated from the seeds of S. marianum using common column chromatography and ODS-HPLC, and identified by 1 H and 13 C NMR spectra. Then, HSCCC with the hexane/ethyl acetate/methanol/water (3 : 7 : 4 : 6, v/v) system was applied to the separation of aromadendrin, jatrointelignan D, silydianin and silybin. In this separation, it was revealed that silybin and silydianin were successfully separated from each other. The present HSCCC system was directly applied to the ethyl acetate extract and resulted in the separation of silybin. The overall results suggested that HSCCC is useful for the separation of bioactive compounds in S. marianum.
Background The AF-201P, a new electromyography (EMG)-based neuromuscular monitor has been developed recently. The aim of this clinical study was to compare two ulnar nerve innervated muscles: the adductor pollicis (AP) muscle and the abductor digiti minimi (ADM) muscle during the recovery from rocuronium-induced neuromuscular block by using EMG AF-201P. Methods Twenty patients undergoing surgery with general anesthesia were enrolled in the study. During total intravenous general anesthesia, train-of-four (TOF) and post-tetanic counts (PTC) responses following 0.9 mg/kg rocuronium administration were concurrently monitored at the AP and the ADM muscles with EMG AF-201P on the opposite arms. At the end of the surgery, sugammadex 2 mg/kg was administered when TOF counts of 2 (TOFC2) was observed at both muscles. The primary outcome of the study was time from administration of rocuronium to first appearance of PTC response (first PTC). The secondary outcomes of the study were time from administration of rocuronium to TOF count of 1 (TOFC1), time from first PTC to TOFC1 (PTC-TOF time), time to TOFC2, and time from administration of sugammadex to TOF ratio ≥ 0.9. Agreement between the two muscles was assessed using the Bland–Altman analysis. Data are expressed as mean ± standard deviation. Results Nineteen patients were included in the analysis. Time to first PTC was significantly faster at the ADM muscle than the AP muscle (24.4 ± 11.4 min vs 32.4 ± 13.1 min, p = 0.006). PTC-TOF time was significantly longer with the ADM muscle than the AP muscle (19.4 ± 7.3 min vs 12.4 ± 10.6 min, p = 0.019). There were no significant differences in time to TOFC2 and sugammadex-facilitated recovery between the two muscles. Bland–Altman analyses showed acceptable ranges of bias and limits of agreement of the two muscles. Conclusions The ADM muscle showed a good agreement with the AP muscle during rocuronium-induced neuromuscular block but faster recovery of PTC response when using EMG. Trial registration UMIN-CTR (Registration No. UMIN000044904). Registered 19 July 2021 -Retrospectively registered, https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view.cgi?recptno=R000051290.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.