Monitoring of neuromuscular transmission by electromyography (II)

Engbaek, J; Skovgaard, L. T.; Fries, Bastian; Kann, T.; Viby‐Mogensen, J.

doi:10.1111/j.1399-6576.1993.tb03811.x

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…Third, tetanic stimulation was not included in the calibration protocol to prevent the staircase phenomenon typical of acceleromyography (amplification induced by repetitive stimulation). 46 As EMG is less subject to baseline drift, 47 we attempted to test the TetraGraph monitor in everyday clinical settings, and we omitted this step, which is not part of routine clinical practice.…”

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…35,44 Although the temperature affects the twitch height (T1), the TOF ratio is not affected. 43 This lack of effect of temperature on the EMG TOF ratio is unlike the marked TOF ratio depression of 20% per C temperature decrease seen with MMG. 45 Manufacturers' recommendations for monitor setup should be followed.…”

Section: Electromyographymentioning

confidence: 89%

“…EMG area under the curve and amplitude appear to reflect neuromuscular transmission equally. 43 The principal disadvantage of EMG monitoring is the signal drift which may partly be a function of hand temperature. 44 However, the drift (approximately 2%-8% decrease in T1 height per C increase) can be compensated for by normalization of the twitch height value after the temperature is stabilized.…”

Section: Electromyographymentioning

confidence: 99%

“…Lead placement and electrode size may affect current density and therefore the required charge for a supramaximal response. Temperature changes affect the EMG electrical signal amplitude to a lesser extent than MMG or AMG, 43 but since neonates are particularly prone to intraoperative hypothermia, this may affect the evoked responses.…”

Section: Pediatric Patientsmentioning

confidence: 99%

“…Any change in stimulus pattern using acceleromyography (AMG) and mechanomyography (MMG) after stability has been achieved is likely to result in a change in the twitch height amplitude. This effect is less pronounced with EMG, although EMG amplitude may increase by 2%–3% per °C decrease in the surface temperature, while the integrated EMG area may vary by 4%–8% per °C 35,36 . For these reasons, studies using EMG monitoring should specify the method for quantification of the compound muscle action potential (cMAP) (i.e., integrated area vs. amplitude vs. duration of cMAP).…”

Section: Reporting Guidelines For Studies On Nmbasmentioning

confidence: 99%

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Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents III: The 2023 Geneva revision

Fuchs‐Buder

Brull

Fagerlund

et al. 2023

Acta Anaesthesiol Scand

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The set of guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents was developed following an international consensus conference in Copenhagen in 1996 (Viby‐Mogensen et al., Acta Anaesthesiol Scand 1996, 40, 59–74); the guidelines were later revised and updated following the second consensus conference in Stockholm in 2005 (Fuchs‐Buder et al., Acta Anaesthesiol Scand 2007, 51, 789–808). In view of new devices and further development of monitoring technologies that emerged since then, (e.g., electromyography, three‐dimensional acceleromyography, kinemyography) as well as novel compounds (e.g., sugammadex) a review and update of these recommendations became necessary. The intent of these revised guidelines is to continue to help clinical researchers to conduct high‐quality work and advance the field by enhancing the standards, consistency, and comparability of clinical studies.There is growing awareness of the importance of consensus‐based reporting standards in clinical trials and observational studies. Such global initiatives are necessary in order to minimize heterogeneous and inadequate data reporting and to improve clarity and comparability between different studies and study cohorts. Variations in definitions of endpoints or outcome variables can introduce confusion and difficulties in interpretation of data, but more importantly, it may preclude building of an adequate body of evidence to achieve reliable conclusions and recommendations. Clinical research in neuromuscular pharmacology and physiology is no exception.

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Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children

et al. 1994

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Monitoring of neuromuscular transmission by electromyography (II)

Cited by 13 publications

References 32 publications

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

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

Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents III: The 2023 Geneva revision

Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children

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