Antagonism of Mivacurium-Induced Neuromuscular Blockade in Man: Edrophonium Dose Requirements at Threshold Train-of-Four Count of Four

Kopman, Aaron F.; Mallhi, Moin U.; Justo, Mona D.; Rodericks, Paul; Neuman, George G.

doi:10.1007/978-4-431-66896-1_78

Cited by 3 publications

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“…Train-of-four ratios in this range are considered to represent clearly inadequate neuromuscular recovery. Nevertheless, because most clinicians cannot detect tactile fade once the TOF fade ratio exceeds 0.40 [9], residual weakness is likely to go undetected in these individuals. Using pooled data, 73%, 43%, and 13% of patients had TOF values in this range at 10, 15, and 20 minutes postreversal (Table 4).…”

Section: Resultsmentioning

confidence: 93%

Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function

Kopman

et al. 2005

Journal of Clinical Anesthesia

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Section: Resultsmentioning

confidence: 93%

Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function

Kopman

et al. 2005

Journal of Clinical Anesthesia

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“…When the train-of-four count is 2, the compound muscle action potential amplitude of the first twitch is 16 to 20% of baseline amplitude. 41,42 Thus, if the baseline value of the first twitch is 7.5 mV, the EMG monitor will at best display a train-of-four count of 1 (20% of 7.5 mV = 1.5 mV). At a baseline compound muscle action potential height of 5 mV, the EMG monitor is likely to display a train-of-four count of 0 or 1 when the acceleromyography-derived train-of-four count is 2.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral and Simultaneous Comparison of Responses from Acceleromyography- and Electromyography-based Neuromuscular Monitors

et al. 2021

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Background The paucity of easy-to-use, reliable objective neuromuscular monitors is an obstacle to universal adoption of routine neuromuscular monitoring. Electromyography (EMG) has been proposed as the optimal neuromuscular monitoring technology since it addresses several acceleromyography limitations. This clinical study compared simultaneous neuromuscular responses recorded from induction of neuromuscular block until recovery using the acceleromyography-based TOF-Watch SX and EMG-based TetraGraph. Methods Fifty consenting patients participated. The acceleromyography and EMG devices analyzed simultaneous contractions (acceleromyography) and muscle action potentials (EMG) from the adductor pollicis muscle by synchronization via fiber optic cable link. Bland–Altman analysis described the agreement between devices during distinct phases of neuromuscular block. The primary endpoint was agreement of acceleromyography- and EMG-derived normalized train-of-four ratios greater than or equal to 80%. Secondary endpoints were agreement in the recovery train-of-four ratio range less than 80% and agreement of baseline train-of-four ratios between the devices. Results Acceleromyography showed normalized train-of-four ratio greater than or equal to 80% earlier than EMG. When acceleromyography showed train-of-four ratio greater than or equal to 80% (n = 2,929), the bias was 1.3 toward acceleromyography (limits of agreement, –14.0 to 16.6). When EMG showed train-of-four ratio greater than or equal to 80% (n = 2,284), the bias was –0.5 toward EMG (–14.7 to 13.6). In the acceleromyography range train-of-four ratio less than 80% (n = 2,802), the bias was 2.1 (–16.1 to 20.2), and in the EMG range train-of-four ratio less than 80% (n = 3,447), it was 2.6 (–14.4 to 19.6). Baseline train-of-four ratios were higher and more variable with acceleromyography than with EMG. Conclusions Bias was lower than in previous studies. Limits of agreement were wider than expected because acceleromyography readings varied more than EMG both at baseline and during recovery. The EMG-based monitor had higher precision and greater repeatability than acceleromyography. This difference between monitors was even greater when EMG data were compared to raw (nonnormalized) acceleromyography measurements. The EMG monitor is a better indicator of adequate recovery from neuromuscular block and readiness for safe tracheal extubation than the acceleromyography monitor. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Subjective evaluation of TOF stimulation with the use of a PNS requires the observer to determine (i) the number of twitches (TOFC), and (ii) the strength of the first response in the train and compare it with the fourth evoked response by tactile or visual means. TOFC of 1, 2, 3 and 4 corresponds approximately to 10%, 20%, 30% and 40% of ST control twitch height . The limitation of TOF ratio is that once it approaches 0.40, most clinicians cannot detect the presence of fade by subjective assessments, and may therefore not administer a reversal drug to ensure adequate recovery of neuromuscular function before tracheal extubation.…”

Section: Patterns Of Nerve Stimulationmentioning

confidence: 99%

Conceptual and technical insights into the basis of neuromuscular monitoring

2017

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Summary Unrecognised postoperative residual neuromuscular block remains a frequent occurrence in recovery rooms. Evidence indicates that current practice continues to perpetuate the status quo, in which 10–40% of patients experience postoperative residual weakness. A departure from the current practice requires small efforts on the clinicians’ part. This review addresses several selected core questions regarding neuromuscular blockade monitoring and provides a framework to rationally discuss and develop basic guidelines for the use of neuromuscular blocking agents in patient care.

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Antagonism of Mivacurium-Induced Neuromuscular Blockade in Man: Edrophonium Dose Requirements at Threshold Train-of-Four Count of Four

Cited by 3 publications

References 0 publications

Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function

Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function

Ipsilateral and Simultaneous Comparison of Responses from Acceleromyography- and Electromyography-based Neuromuscular Monitors

Conceptual and technical insights into the basis of neuromuscular monitoring

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