Intraoperative Acceleromyography Monitoring Reduces Symptoms of Muscle Weakness and Improves Quality of Recovery in the Early Postoperative Period

Murphy, Glen S.; Szokol, Joseph W.; Avram, Michael J.; Greenberg, Steven B.; Marymont, Jesse H.; Vender, Jeffery S.; Gray, Jayla; Landry, Elizabeth; Gupta, Dhanesh K.

doi:10.1097/01.sa.0000414677.82085.0d

Cited by 26 publications

(33 citation statements)

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“…Figure 3 depicts how this monitor is applied on the patient. This device may help reduce signs and symptoms of residual neuromuscular weakness along with respiratory complications (hypoxemia and airway obstruction) (41,42). Research is needed regarding quantitative monitoring and its utilization in the ICU.…”

Section: Monitoringmentioning

confidence: 98%

The Use of Neuromuscular Blocking Agents in the ICU

Greenberg

Vender

2013

Critical Care Medicine

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Intensivists use neuromuscular blocking agents for a variety of clinical conditions, including for emergency intubation, acute respiratory distress syndrome, status asthmaticus, elevated intracranial pressure, elevated intra-abdominal pressure, and therapeutic hypothermia after ventricular fibrillation-associated cardiac arrest. The continued creation and use of evidence-based guidelines and protocols could ensure that neuromuscular blocking agents are used and monitored appropriately. A collaborative multidisciplinary approach coupled with constant review of the pharmacology, dosing, drug interactions, and monitoring techniques may reduce the adverse events associated with the use of neuromuscular blocking agents.

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Section: Monitoringmentioning

confidence: 98%

The Use of Neuromuscular Blocking Agents in the ICU

Greenberg

Vender

2013

Critical Care Medicine

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“…In brief, the aim of the original study was to determine the effect of AMG monitoring on the incidence of signs and symptoms of residual muscle weakness during the first 60 minutes of PACU stay. 11 The study protocol had several predetermined objectives, including a secondary analysis to determine the association between residual neuromuscular blockade and impaired clinical recovery in the PACU. This secondary analysis is the aim of the present study.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

“…2,10 Furthermore, in a recent investigation, we determined that patients randomized to receive acceleromyography (AMG) monitoring had significantly fewer symptoms of residual paresis during the first 60 minutes of the PACU stay compared with patients assessed with conventional qualitative devices (peripheral nerve stimulators). 11 Although a general association between residual neuromuscular blockade and symptoms of muscle weakness was suggested, a detailed analysis of this relationship was not conducted. 11 The aim of the present investigation was to perform a secondary analysis of these data to determine the incidence and severity of symptoms of muscle weakness in patients with (defined as a TOF ratio <0.9) and without (defined as a TOF ratio ≥0.9) residual neuromuscular blockade.…”

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confidence: 99%

“…11 Although a general association between residual neuromuscular blockade and symptoms of muscle weakness was suggested, a detailed analysis of this relationship was not conducted. 11 The aim of the present investigation was to perform a secondary analysis of these data to determine the incidence and severity of symptoms of muscle weakness in patients with (defined as a TOF ratio <0.9) and without (defined as a TOF ratio ≥0.9) residual neuromuscular blockade. A threshold of 0.9 was selected based on data demonstrating an association between AMG-measured TOF ratios <0.9 on admission to the PACU and adverse postoperative events (hypoxemia, prolonged PACU length of stay).…”

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confidence: 99%

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Postoperative Residual Neuromuscular Blockade Is Associated with Impaired Clinical Recovery

Murphy

Szokol

Avram

et al. 2013

Anesthesia &Amp; Analgesia

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134

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“…15 In a clinical trial of surgical patients randomized to AMG (TOF-Watch) or qualitative (peripheral nerve stimulator) monitoring, patients in the AMG group had significantly fewer symptoms of muscle weakness in the PACU during the first 60 minutes, and overall quality of recovery at the time of PACU discharge was significantly improved. 14 In a further analysis of the data, patients with TOF ratios less than 0.9 on arrival to the PACU had a greater number of symptoms of muscle weakness as well as poorer overall quality of recovery. 16 Question 4: Should an Anticholinesterase Reversal Agent Be Administered to Most Patients at the End of Surgery?…”

Section: Question 2: Does Quantitative Neuromuscularmentioning

confidence: 99%

Neuromuscular Management and Patient Outcomes

Murphy¹

2015

ASA Refresher Courses in Anesthesiology

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Learning Objectives:As a result of completing this activity, the participant will be able to Discuss neuromuscular monitoring and its impact on postoperative outcomes Describe the effect of reversal of neuromuscular blocking agents on the incidence of postoperative residual neuromuscular blockade Explain principles of neuromuscular management that may beneficially impact postoperative recovery in surgical patients Author Disclosure Information:Dr. Murphy has disclosed that he receives consulting fees and honoraria from Merck. P ostoperative residual neuromuscular blockade after general anesthesia is a common complication observed in the postanesthesia care unit (PACU). Recent large-scale clinical investigations have demonstrated that up to 24 to 42% of surgical patients arrive in the PACU with evidence of incomplete neuromuscular recovery. 1,2 Although most clinicians are now using intermediate-acting muscle relaxants, the risk of a residual neuromuscular block does not appear to be decreasing over time. In a metaanalysis of data from 24 clinical trials, the pooled rate of residual block, defined as a train-of-four (TOF) ratio less than 0.9, was 41% when studies using intermediate-acting neuromuscular blocking agents (NMBAs) were analyzed 3 (Table 1).To reliably detect and treat residual neuromuscular block, quantitative neuromuscular monitors (which measure and quantify muscle strength on a 0 to 100% or 0 to 1.0 scale) are required. A large number of laboratory and clinical investigations have demonstrated that TOF ratios, measured with a quantitative neuromuscular monitor, must recover to at least 0.9 (or 90%) to exclude clinically significant residual block. Investigations with awake volunteers have demonstrated that subjects with a TOF ratio less than 0.9 have upper airway obstruction, reduced upper airway tone and diameter, pharyngeal dysfunction, impaired hypoxic ventilatory control, decreased upper esophageal tone and an increased risk for aspiration, and unpleasant symptoms of muscle weakness. 4 Epidemiological outcome investigations have suggested an association between incomplete neuromuscular recovery and major morbidity (primarily respiratory events) and mortality. 4,5 Clinical trials have demonstrated that patients with a TOF ratio less than 0.9 in the PACU are at increased risk for airway obstruction, hypoxemic events, postoperative pulmonary complications, unpleasant symptoms of muscle weakness, and prolonged PACU admission times. 4 Careful management of neuromuscular blockade in the perioperative period may decrease the incidence of 80

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Intraoperative Acceleromyography Monitoring Reduces Symptoms of Muscle Weakness and Improves Quality of Recovery in the Early Postoperative Period

Cited by 26 publications

References 1 publication

The Use of Neuromuscular Blocking Agents in the ICU

The Use of Neuromuscular Blocking Agents in the ICU

Postoperative Residual Neuromuscular Blockade Is Associated with Impaired Clinical Recovery

Neuromuscular Management and Patient Outcomes

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