An observational study comparing the performance of TOF-Cuff with TOF-Scan monitoring during anaesthetic induction in clinical routine

Markle, Andrew; Horn, Katja; Welter, JoEllen; Dullenkopf, Alexander

doi:10.5114/ait.2020.98124

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…One should also approach the proposed correction factors with caution, as they have been calculated on a small sample and require verification on larger datasets. Finally, both methods have their own limitations: the TOF-Cuff indicates readiness for intubation significantly earlier in patients with obesity than in those with normal weight [ 4 ], whereas the TOF-Scan can be worse at estimating block at the central muscles, such as the diaphragm and vocal cords [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…The response of the adductor pollicis muscle to electrical stimulation of the ulnar nerve is clinically used as a routine method of monitoring neuromuscular blockade [ 3 ]. Typically, an electrical stimulus is applied through adhesive electrodes positioned on the medial lower arm over the ulnar nerve to elicit nerve stimulation, for example, with the TOF-Scan ® ; the resultant motor response is quantified in terms of acceleration [ 4 ]. The frequently used paradigm is the train-of-four (TOF), in which the motor responses from the fourth and first stimuli are compared and presented as a percentage, denoted as the TOF ratio (TOF ratio ) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Radkowski,

Ruść,

Kęska

et al. 2024

Med Sci Monit

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Background Mivacurium is a non-depolarizing neuromuscular blocking agent. TOF-Cuff ® is a device that monitors intraoperative neuromuscular blockade and blood pressure. TOF-Scan ® measures muscle relaxation status of an anaesthetized patient. This study included 36 patients aged 18 to 75 years presenting for elective surgery, to compare neuromuscular blockade measured using the TOF-Cuff of the upper arm and the TOF-Scan of the facial corrugator supercilii muscle during general anesthesia and following administration of mivacurium. Material/Methods Train-of-four (TOF) values were obtained every 30 s before intubation and successively every 5 min until extubation. Results The median onset time for TOF-Cuff was longer than for TOF-Scan (210 s vs 90 s, P <0.00001). Multiplying the time to relaxation (according to TOF-Scan) by 1 to 8, respectively, provided concordance with the TOF-Cuff result for the following cumulative percentages of patients: 5.5%, 38.9%, 58.3%, 77.8%, 83.3%, 86.1%, 88.9%, and 91.7%. Analogue values for time to recovery from the last dose were 11.1%, 63.9%, 83.3%, 86.1%, 86.1%, 88.9%, 88.9%, and 91.7%. The proportion of patients who still had TOF ratio =0 in the assessment performed at min 15 did not differ significantly between these 2 methods ( P =0.088). Both TOF-Scan and TOF-Cuff showed a false-negative result in patients with clinical symptoms of preterm recovery; the numerical difference favored TOF-Cuff (1.6% vs 2.1%) but without statistical significance ( P =0.2235). Conclusions When measurement on the limb is not possible, TOF-Scan on the eyelid can be an alternative for TOF-Cuff on the upper arm, if the time to relaxation is multiplied by at least 8, which is enough for 90% of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Radkowski,

Ruść,

Kęska

et al. 2024

Med Sci Monit

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“…In another scenario of predictable difficult intubation (e.g., congenital defects, traumatic injuries) when the rocuronium dose of 1.2 mg/kg is recommended, immediate reversal of blockade needs higher sugammadex doses in all age groups from 6.5 mg/kg for a 5 kg infant to 8.3 mg/kg for a 40 kg child, and even 9 mg/kg for patients weighing 70 kg [ 29 ]. Similarly, shortening the time to 1.5 min requires a further increase in the dose by a factor of 1.5, which means an effective dose for an infant is 8.8 mg/kg and for a teenager is 12–13 mg/kg of sugammadex.…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetic–Pharmacodynamic Modeling and Probability of Target Attainment Analysis of Rocuronium and Sugammadex in Children Undergoing Surgery

Grześkowiak

Bienert

Wiczling

et al. 2022

Eur J Drug Metab Pharmacokinet

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Background and Objectives Probability of target attainment (PTA) curves are commonly used to support dose recommendations of antibiotics for different patient groups. In this study we propose PTA analysis to optimize sugammadex dosing in children. Methods This study involved data from an observational cohort study of 30 American Society of Anesthesiologists (ASA) Physical Status I and II children undergoing surgery requiring muscle relaxation. All patients received 0.6 mg/kg rocuronium, with sugammadex administered at the end of surgery in three different doses (0.5, 1.0, and 2.0 mg/kg) to reverse the neuromuscular blockade. Results The data were analyzed using a population Bayesian-based approach. The developed model was used to simulate pharmacokinetic-pharmacodynamic profiles for different patient groups and dosing regimens before the PTA analysis was performed to translate these simulations into a clinically useful measure. The target was defined as neuromuscular blockade reversal measured by Train-of-Four (TOF ratio > 90%) at 1.5, 3, and 5 min post sugammadex dose. The sugammadex doses leading to 90% PTA were determined for different patients' body weights, rocuronium doses, and time gaps between rocuronium and sugammadex administration assuming the model, priors, and gathered data. For comparison, PTA curves for a range of clinical scenarios are provided to illustrate the usefulness of PTA analysis in selecting the appropriate dose for a given patient. Conclusions The proposed PTA analysis is useful to support the sugammadex dose selection in different clinical scenarios. Trial Registration The study was registered by ClinicalTrials.gov under number NCT04851574 on

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“…It was concluded that the two devices were not interchangeable. 30 A 2018 study comparing TOF-Cuff with AMG showed that upper extremity neuromuscular transmission measurement with the TOF-Cuff should not be used interchangeably with EMG or AMG measurements on the adductor pollicis muscle. Recovery to TOFR> 0.9 took an average of 25 minutes longer with EMG or AMG compared to the TOF-Cuff.…”

Section: Main Sectionsmentioning

confidence: 99%

Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology – A Review

Radkowski,

Barańska,

Mieszkowski

et al. 2024

IJGM

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The administration of general anesthesia is a crucial aspect of surgery. However, it can pose significant risks to patients, such as respiratory depression and prolonged neuromuscular blockade. To avoid such complications, it is essential to monitor neuromuscular transmission during anesthesia. While clinical tests have been used for decades to evaluate muscle function, they are now known to be unreliable, and relying on them increases the risk of postoperative complications. Thankfully, there are now six methods available for neuromuscular monitoring during anesthesia: mechanomyography, acceleromyography, electromyography, kinemyography, phonomyography, and compressomyography. Each of these methods differs in terms of their approach and methodology, and their importance in clinical practice varies accordingly. Mechanomyography involves measuring the mechanical response of a muscle to nerve stimulation, while acceleromyography measures the acceleration of muscle contraction. Electromyography records the electrical activity of muscles, while kinemyography tracks muscle movement. Phonomyography records the sound waves produced by contracting muscles, and compressomyography involves monitoring the pressure changes in a muscle during contraction. Overall, understanding the differences between these methods and their clinical significance is crucial for anesthesiologists. This review aims to provide an updated understanding of the current methods available for neuromuscular monitoring during anesthesia, so that anesthesiologists can make informed decisions about patient care and reduce the risk of postoperative complications.

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An observational study comparing the performance of TOF-Cuff with TOF-Scan monitoring during anaesthetic induction in clinical routine

Cited by 5 publications

References 16 publications

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Population Pharmacokinetic–Pharmacodynamic Modeling and Probability of Target Attainment Analysis of Rocuronium and Sugammadex in Children Undergoing Surgery

Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology – A Review

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