Dose‐response relationship of rocuronium: A comparison of electromyographic vs. acceleromyographic‐derived values

Kopman, Aaron F.; Chin, Wanda A.; Moe, Jimmy

doi:10.1111/j.1399-6576.2005.00641.x

Cited by 13 publications

(9 citation statements)

References 17 publications

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“…However, there was no difference in ED 95 . In contrast, Kopman et al 42 found no differences in ED 50 , All three studies were nonrandomized and did not include a sample size analysis, and only Meretoja et al, 41 1989, described dropouts. In none of the studies was the stimulation pattern synchronized or used with the same frequency.…”

Section: Group 1: Use Of Acceleromyography For Establishing Dose-respmentioning

confidence: 96%

“…We found three articles comparing acceleromyography to mechanomyography 40 or electromyography 41,42 for construction of dose-response curves (table 1). The study by McCluskey et al 40 was stated to be randomized, but the concealed allocation was not described.…”

Section: Group 1: Use Of Acceleromyography For Establishing Dose-respmentioning

confidence: 99%

“…The study of McCluskey et al 40 was performed in pediatric patients, and although the study was otherwise methodologically sound, it was performed in only 15 patients (without a power analysis). The study of Kopman et al 42 was performed in adults with acceleromyography and electromyography ipsilaterally and with a preload applied. However, a novel nonvalidated method was used to construct the dose-response curve (Hill equation).…”

Section: Group 1: Use Of Acceleromyography For Establishing Dose-respmentioning

confidence: 99%

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Acceleromyography for Use in Scientific and Clinical Practice

2008

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This systematic review describes the evidence on the use of acceleromyography for perioperative neuromuscular monitoring in clinical practice and research. The review documents that although acceleromyography is widely used in research, it cannot be used interchangeably with mechanomyography and electromyography for construction of dose-response curves or for recording different pharmacodynamic variables after injection of a neuromuscular blocking agent. Some studies indicate that it may be beneficial to use a preload to increase the precision of acceleromyography, and to "normalize" the train-of-four ratio to decrease the bias in relation to mechanomyography and electromyography. However, currently the evidence is insufficient to support the routine clinical use of preload and "normalization." In contrast, there is good evidence that acceleromyography improves detection of postoperative residual paralysis. A train-of-four ratio of 1.0 predicts with a high predictive value recovery of pulmonary and upper airway function from neuromuscular blockade.

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Section: Group 1: Use Of Acceleromyography For Establishing Dose-respmentioning

confidence: 96%

Section: Group 1: Use Of Acceleromyography For Establishing Dose-respmentioning

confidence: 99%

Section: Group 1: Use Of Acceleromyography For Establishing Dose-respmentioning

confidence: 99%

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Acceleromyography for Use in Scientific and Clinical Practice

2008

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“…20 Although acceleromyography may exhibit some intraindividual variation, it appears to be a valid method for determining drug potency when a specific population is studied. 21 Acceleromyography uses a peripheral nerve stimulator that delivers four rapid electric pulses to the ulnar nerve through surface electrodes placed on the wrist. Contraction of the adductor pollicis results in movement of a thumb transducer, generating response information that is subsequently recorded.…”

Section: Train-of-four Monitoringmentioning

confidence: 99%

Sugammadex: A Novel Agent for the Reversal of Neuromuscular Blockade

2007

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To achieve spontaneous ventilation after completion of surgery, the nondepolarizing effects on skeletal muscle relaxation are often reversed by administration of an acetylcholinesterase inhibitor. However, these agents increase acetylcholine at both the neuromuscular junction and the muscarinic receptors. Therefore, coadministration of an anticholinergic agent is required to prevent parasympathetic adverse effects. In addition, a relative pharmacologic ceiling effect is seen with inhibition of acetylcholinesterase, necessitating some recovery of neuromuscular function before an acetylcholinesterase inhibitor is administered. Sugammadex is a new modified gamma-cyclodextrin compound under clinical investigation in the United States. It does not interact with cholinergic mechanisms to elicit reversal. Instead, it is a selective relaxant binding agent and acts by forming a 1:1 complex with steroidal nondepolarizing neuromuscular blockers in the plasma, lowering the effective concentration available at the receptor. Due to its selectivity, sugammadex does not inhibit the effects of nondepolarizing agents of the benzylisoquinolinium class. In contrast to acetylcholinesterase inhibition, sugammadex is effective even when administered during profound blockade, and it does not require coadministration of an anticholinergic agent. It provides a novel mechanism of action for reversal of the neuromuscular block induced by nondepolarizing aminosteroidal agents.

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“…Hence, devices that are easier to apply, such as acceleromyography (AMG) and electromyography (EMG), are used more often clinically. Although AMG can be a useful method for the measurement of neuromuscular blockade in neonates and infants [ 4 5 ], several studies have shown that AMG is less precise than EMG [ 6 7 8 ]. Moreover, we have encountered a technical problem in getting a proper baseline calibration of a single twitch of AMG before administration of a neuromuscular blocking agent in children.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical validation of acceleromyography and electromyography in children who were administered rocuronium during general anesthesia: a prospective double-blinded randomized study

Jung

Hwang

Won

et al. 2016

Korean J Anesthesiol

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BackgroundElectromyography and acceleromyography are common neuromuscular monitoring devices. However, questions still remain regarding the use of acceleromyography in children. This study compared the calibration success rates and intubation conditions in children after obtaining the maximal blockade depending on each of the devicesMethodsChildren, 3 to 6 years old, were randomly allocated to the TOF-Watch SX acceleromyography group or the NMT electromyography group. The induction was performed with propofol, fentanyl, and rocuronium. The bispectral index and 1 Hz single twitch were monitored during observation. The calibration of the each device was begun when the BIS dropped to 60. After successful calibration, rocuronium 0.6 mg/kg was injected. A tracheal intubation was performed when the twitch height suppressed to 0. The rocuronium onset time (time from administration to the maximal depression of twitch height) and intubating conditions were rated in a blinded manner.ResultsThere was no difference in the calibration success rates between the two groups; and the calibration time in the electromyography group (16.7 ± 11.0 seconds) was shorter than the acceleromyography group (28.1 ± 13.4 seconds, P = 0.012). The rocuronium onset time of the electromyography group (73.6 ± 18.9 seconds) was longer than the acceleromyography group (63.9 ± 18.8 seconds, P = 0.042) and the intubation condition of the electromyography group (2.27 ± 0.65) was better than the acceleromyography group (1.86 ± 0.50, P = 0.007).ConclusionsElectromyography offers a better compromise than acceleromyography with respect to the duration of calibration process and surrogate for the optimal time of tracheal intubation in children.

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Dose‐response relationship of rocuronium: A comparison of electromyographic vs. acceleromyographic‐derived values

Cited by 13 publications

References 17 publications

Acceleromyography for Use in Scientific and Clinical Practice

Acceleromyography for Use in Scientific and Clinical Practice

Sugammadex: A Novel Agent for the Reversal of Neuromuscular Blockade

Comparison of clinical validation of acceleromyography and electromyography in children who were administered rocuronium during general anesthesia: a prospective double-blinded randomized study

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