Acceleromyography for Use in Scientific and Clinical Practice

Claudius, Casper; Viby‐Mogensen, J.

doi:10.1097/aln.0b013e318173f62f

Cited by 132 publications

(91 citation statements)

References 93 publications

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“…With AMG, normal TOFR in the absence of paralysis is often[1.0 with values C 1.3 being common. 23 This means that an AMG reading of 0.9 might be insufficient. Moreover, some versions of the TOF-Watch do not provide values[1.0.…”

Section: Quantitative Monitoringmentioning

confidence: 99%

Residual paralysis: a real problem or did we invent a new disease?

Donati

2013

Can J Anesth/J Can Anesth

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Purpose Over the past three decades, many studies have shown a high proportion of patients in the recovery room with residual neuromuscular blockade after anesthesia. The purpose of this Continuing Professional Development module is to present the physiological consequences of residual paralysis, estimate the extent of the problem, and suggest solutions to prevent its occurrence. Principal findings Residual paralysis is defined as a train-of-four ratio (TOFR) \ 0.9 at the adductor pollicis. While tidal volume and, to a lesser extent, vital capacity are well preserved as the intensity of blockade increases, the probability of airway obstruction, impaired swallowing, and pulmonary aspiration increases markedly as TOFR decreases. In recent studies, incidences of residual paralysis from 4-57% have been reported, but surveys indicate that anesthesiologists estimate the incidence of the problem at 1% or less. The decision to administer neostigmine or sugammadex should be based on the degree of spontaneous recovery at the adductor pollicis muscle (thumb), not on recovery at the corrugator supercilii (eyebrow). The most important drawback of neostigmine is its inability to reverse profound blockade, which is a consequence of its ceiling effect. When spontaneous recovery reaches the point where TOFR [ 0.4 or four equal twitch responses are seen, reduced doses of neostigmine may be given. The dose of sugammadex required in a given situation depends on the intensity of blockade. Conclusion Careful monitoring and delaying the administration of neostigmine until four twitches are observed at the adductor pollicis can decrease the incidence of residual paralysis. The clinical and pharmacoeconomic effects of unrestricted sugammadex use are unknown at this time. ObjectivesAfter reading this module, the reader should be able to:1. Describe the physiological effects of residual neuromuscular blockade 2. Define and justify the current threshold used for residual paralysis 3. Interpret the information provided by qualitative and quantitative monitors 4. Decide the dose and timing of administration of neostigmine 5. Manage neuromuscular blockade and reversal during and after anesthesia.In 1979, Viby-Mogensen et al. 1 reported that 42% of patients receiving non-depolarizing neuromuscular blocking agents during anesthesia followed by neostigmine at the end of the procedure had neuromuscular weakness in the recovery room, as documented by a train-of-four ratio 123Can J Anesth/J Can Anesth (2013) 60:714-729 DOI 10.1007 (TOFR) \ 0.7. This first description of what was later termed residual paralysis, residual curarization, or postoperative residual curarization was followed by many other observations in many countries around the world and in different settings. The introduction of shorter-acting agents, such as vecuronium and atracurium and later rocuronium and cisatracurium, to replace the longer-acting agents available in 1979 led to a decrease in the incidence of residual paralysis. 2 Nevertheless, many lines of evidence now...

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Section: Quantitative Monitoringmentioning

confidence: 99%

Residual paralysis: a real problem or did we invent a new disease?

Donati

2013

Can J Anesth/J Can Anesth

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“…Uno de los métodos utilizados para la monitorización de la función neuromuscular consiste en la estimulación eléctrica de un nervio motor periférico y la valoración de la respuesta del músculo inervado por él (1)(2)(3). Entre las formas más novedosas de cuantificar esta respuesta, se halla la aceleromiografía, que consiste en adquirir información cinética (aceleración) del músculo inervado para cuantificar objetivamente el bloqueo neuromuscular (1-3).…”

Section: Introductionunclassified

Ensayos en Ambiente Hospitalario de Técnicas de Monitorización de Bloqueo Neuromuscular: Resultados Preliminares

Viaña¹,

Fernández²,

Escobar

et al. 2014

Ciencia e Innovación en Salud

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RESUMENIntroducción: La respuesta de grupos musculares a consecuencia de la estimulación de nervios periféricos, permite a los anestesiólogos evaluar la profundidad del bloqueo neuromuscular durante la anestesia general. Objetivo: Evaluar en la práctica médica el prototipo de un monitor cubano de bloqueo neuromuscular y sus algoritmos, para calcular indicadores objetivos de relajación muscular. Materiales y métodos: Se escogieron cirugías de corta duración y se monitorizó la función neuromuscular intraoperatoria de pacientes. Los ensayos se realizaron a partir de la estimulación de los nervios mediano y cubital con el patrón Train-of-Four (TOF) a intensidad de corriente supramáxima, registrándose la respuesta cinética del dedo pulgar y calculando automáticamente los indicadores de relajación muscular. El protocolo fue aprobado por el Consejo Científico y el Comité de Ética del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", en el marco de un proyecto de investigación conjunta entre el ICID -Tecnología Médica Digital y el Hospital. Resultados: Se presenta evidencia de la monitorización de cinco casos reales, para los que se construyeron gráficos del comportamiento en el tiempo de los indicadores de relajación muscular. El monitor sometido a ensayos se mantuvo funcionando de forma estable durante todos los actos quirúrgicos. Conclusión: A criterio de los especialistas involucrados, los indicadores de relajación muscular registrados durante los ensayos mostraron significativa correspondencia con la clínica de los pacientes, lo que proporciona evidencias a favor de las técnicas de monitorización implementadas.Palabras Clave:Bloqueo neuromuscular, relajación muscular, monitorización intraoperatoria(Fuente: DeCS). ABSTRACTIntroduction: In order to evaluate the magnitude of neuromuscular blocking during anesthesia, the anesthesiologists consider the muscular response to peripheral nerves stimulation. Objective: Study aims to calculate muscle relaxation indicators, through neuromuscular blocking and its algorithms using a Cuban made monitoring device during the medical procedure. Materials and methods: Thumb kinetic response and muscles relaxation indicators were registered and calculated automatically; for this purpose, median and nerves trials using Troin-of -Four (TOF) were conducted in shorter surgeries, which allowed to monitor patients' neuromuscular, intraoperative function. Scientific consel and the Committee of Ethics of the Clinical Surgical Hospital "HermanosAmeijeiras" approved the protocol, based on a research project conducted by the ICID -Medical Digital technology and the Hospital. Results: the monitoring was stable during all medical procedures as indicated on graph data obtained during five sample cases indicating muscle relaxation indicators. Conclusion: muscle relaxation indicators registered during trials showed significant relevance relation to patient's clinical history, giving support to evidence of the monitoring implemented techniques based on specialists' criteria.

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“…22 Acceleromyography is more often used for detection of residual paralysis in research and during surgery than in postoperative clinical practice; its efficacy after surgery has not been established. 23 Because patients in the recovery phase of anesthesia have increased motor movement, the occurrence of artifact increases and the reliability of the instrument is diminished. Another concern is the lack of consensus about the TOF ratio needed to exclude clinically important RNMB.…”

Section: Clinical Monitoring Of Neuromuscular Blockadementioning

confidence: 99%

“…Another concern is the lack of consensus about the TOF ratio needed to exclude clinically important RNMB. 23,25 TOF is an assessment that involves stimulation of peripheral nerves. A series of 4 light shocks are applied to a peripheral nerve, and visual observation of the muscular response to each shock is used to measure the degree of neuromuscular blockade.…”

Section: Clinical Monitoring Of Neuromuscular Blockadementioning

confidence: 99%

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Residual Neuromuscular Blockade in Critical Care

Wilson

Collins

Rowan

2012

Critical Care Nurse

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Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

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Acceleromyography for Use in Scientific and Clinical Practice

Cited by 132 publications

References 93 publications

Residual paralysis: a real problem or did we invent a new disease?

Residual paralysis: a real problem or did we invent a new disease?

Ensayos en Ambiente Hospitalario de Técnicas de Monitorización de Bloqueo Neuromuscular: Resultados Preliminares

Residual Neuromuscular Blockade in Critical Care

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