Comparison of the TOF-Cuff® monitor with electromyography and acceleromyography during recovery from neuromuscular block

Krijtenburg, Piet; Honing, Maarten; Martini, C.H.; Olofsen, Erik; Elst, H.J. van; Scheffer, Gert Jan; Dahan, Albert; Keijzer, Christiaan; Boon, Martijn

doi:10.1016/j.bja.2018.11.011

Cited by 15 publications

(14 citation statements)

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“…Our study sample size was similar to other reported investigations [7,14], but still relatively small and homogenous, which limits our ability to generalize our results. Using the gold standard in neuromuscular monitoring, mechano-or electromyography, as our control device could have strengthened the robustness of our investigation.…”

Section: Discussionsupporting

confidence: 71%

“…A newly developed neuromuscular monitor, the TOF-Cuff® (RGB medical devices; Madrid, Spain), incorporates both stimulating electrodes and sensors into a blood pressure cuff [5][6][7]. In addition to the ease of application and use, this dual-purpose device does not require specific limb positioning or expensive components used with other monitoring systems.…”

Section: Introductionmentioning

confidence: 99%

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Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries

et al. 2019

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Purpose The aim of this study was to compare two devices for neuromuscular monitoring during anesthetic induction. TOF-Cuff® was installed on the lower leg stimulating the tibial nerve, while the more conventional TOF-Scan® was installed over the ulnar nerve at the wrist. Methods Twenty adult patients were enrolled in this prospective, controlled study. Train-of-four (TOF) was recorded every 15 s until TOF ratio of 0%. Mean arterial blood pressure (MAP) was assessed with TOF-Cuff® and with standard anesthesia monitoring from the brachial artery. MAP was measured before and after anesthetic induction. Time to TOF ratio = 0% was compared with one-sample t test and Bland–Altman plots. Results Patients received 0.53 ± 0.09 mg atracurium per kg body weight intravenously. Mean time to TOF ratio = 0% was 150.8 s (± 43.7) for TOF-Scan®, and 174.4 s (± 42.7) for TOF-Cuff® (p = 0.1356). Bias was − 15.9 (95% confidence interval − 37.5 to 5.6) with 95% limits of agreement of − 95.2 to 63.3. Twenty-five percent of the patients had a technical issue with a TOF-Cuff® measurement. For MAP, mean difference was 1.4 (95% confidence interval − 2.4 to 5.2) with 95% limits of agreement of − 22.7 to 25.5. Conclusion The time from administration of a common dose of atracurium to a TOF ratio of 0% assessed with TOF-Cuff® stimulating the tibial nerve compared to TOF-Scan® stimulating the ulnar nerve showed large limits of agreement in Bland–Altman analysis. There was a high failure rate with TOF-Cuff® measurements on the lower leg.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries

et al. 2019

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“…Their common feature is their user-friendly interface, but validation studies are needed to compare their performance and usability to existing monitors and to prove their consistency and reliability in the clinical setting. [10][11][12][13][14][15][16] Until recently, the most frequently used neuromuscular monitors were acceleromyography-based devices. To obtain precise train-of-four ratio measurements with these devices, clinicians need to take several precautions (such as fixation of the arm in supine position, use of preload on the thumb, calibration of the device, and normalization of results).…”

Section: What We Already Know About This Topicmentioning

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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“…TOF-cuff has the advantage of convenience because it uses a modified blood pressure cuff on the arm for neuromuscular monitoring, but has limitations of underestimation in the measurement of TOF ratios and inaccuracy for the prevention of RNMB in comparison to the EMG or AMG [27]. Recent studies showed delayed recovery to a normalized TOF ratio of >0.9, approximately 25-minute longer, with EMG or AMG compared with TOF-Cuff [28].…”

Section: Modern Technical Development Of Neuromuscular Monitoring Devicesmentioning

confidence: 99%

A short review of history and technical advances in quantitative neuromuscular monitoring devices

Lee

Jung

2021

Med Biol Sci Eng

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Anesthetic procedures using a neuromuscular blocking drug (NMBD) always have a potential risk of residual neuromuscular block (RNMB) associated with serious respiratory complications despite the use of reversal agents. Due to the risk of RNMB, neuromuscular monitoring is a very important tool for assessing patient safety. Recently, the importance of quantitative neuromuscular monitoring has been highlighted because of the advent of sugammadex, which determines dosage based on the degree of NMB. Neuromuscular monitoring, which has been used clinically since the 1970s, is an appropriate method for assessing the level of neuromuscular blockade (NMB) after the use of a NMBD during anesthesia. Although the basic principles have not changed considerably, recent technical advances in neuromuscular monitoring devices can help anesthesiologists with convenient quantitative neuromuscular monitoring to accurately evaluate the levels of NMB, choose an appropriate NMBD, and avoid RNMB. The recently released electromyography-based devices provide more accurate values than acceleromyography (AMG). Although AMG has a problem with overestimation, modern AMG devices with new three-dimensional technology overcome this limitation. Anesthesiologists should increase their knowledge of neuromuscular mechanisms and monitoring, including how to use the latest device for proper neuromuscular monitoring and patient safety. In this review, we have explored the short history of neuromuscular monitoring devices and the latest trends in technology development.

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Comparison of the TOF-Cuff® monitor with electromyography and acceleromyography during recovery from neuromuscular block

Cited by 15 publications

References 10 publications

Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries

Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries

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

A short review of history and technical advances in quantitative neuromuscular monitoring devices

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