Neuromuscular monitoring during modified rapid sequence induction: A comparison of TOF-Cuff® and TOF-Scan®

Chau, Ivan; Horn, Katja; Dullenkopf, Alexander

doi:10.1016/j.auec.2020.02.005

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Nevertheless, further studies with other muscle relaxants are needed to determine whether the corrugator supercilii muscle acceleromyography provides an accurate assessment of neuromuscular function under general anesthesia. So far, to the best of our knowledge, a similar study using different neuromuscular blocking agents has been conducted only by Chau et al, who assessed both methods after the administration of atracurium, obtaining similar results to ours [ 31 ].…”

Section: Discussionsupporting

confidence: 79%

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Radkowski,

Ruść,

Kęska

et al. 2024

Med Sci Monit

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Background Mivacurium is a non-depolarizing neuromuscular blocking agent. TOF-Cuff ® is a device that monitors intraoperative neuromuscular blockade and blood pressure. TOF-Scan ® measures muscle relaxation status of an anaesthetized patient. This study included 36 patients aged 18 to 75 years presenting for elective surgery, to compare neuromuscular blockade measured using the TOF-Cuff of the upper arm and the TOF-Scan of the facial corrugator supercilii muscle during general anesthesia and following administration of mivacurium. Material/Methods Train-of-four (TOF) values were obtained every 30 s before intubation and successively every 5 min until extubation. Results The median onset time for TOF-Cuff was longer than for TOF-Scan (210 s vs 90 s, P <0.00001). Multiplying the time to relaxation (according to TOF-Scan) by 1 to 8, respectively, provided concordance with the TOF-Cuff result for the following cumulative percentages of patients: 5.5%, 38.9%, 58.3%, 77.8%, 83.3%, 86.1%, 88.9%, and 91.7%. Analogue values for time to recovery from the last dose were 11.1%, 63.9%, 83.3%, 86.1%, 86.1%, 88.9%, 88.9%, and 91.7%. The proportion of patients who still had TOF ratio =0 in the assessment performed at min 15 did not differ significantly between these 2 methods ( P =0.088). Both TOF-Scan and TOF-Cuff showed a false-negative result in patients with clinical symptoms of preterm recovery; the numerical difference favored TOF-Cuff (1.6% vs 2.1%) but without statistical significance ( P =0.2235). Conclusions When measurement on the limb is not possible, TOF-Scan on the eyelid can be an alternative for TOF-Cuff on the upper arm, if the time to relaxation is multiplied by at least 8, which is enough for 90% of patients.

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Section: Discussionsupporting

confidence: 79%

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Radkowski,

Ruść,

Kęska

et al. 2024

Med Sci Monit

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“…The sample size was chosen in accordance with our previous investigation concerning TS [8] and other similar studies [9,[11][12][13][14][15]. We already compared the TS and the TOF Watch accelerometer [8]; in this study, 32 patients were included and a mean bias of 26 s was observed between the two types of accelerometers.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021

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Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

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“…However, due to high variability and wide compliance limits found, the authors concluded that these devices cannot be used interchangeably. 33 In a 2017 study comparing TOF-Cuff with MMG and with invasive blood pressure measurement, TOF-Cuff was shown to be effective and safe in monitoring neuromuscular blockade and NIBP (Non-Invasive Blood Pressure), but it cannot be used interchangeably with MMG. 34 In a study by Markle et al from 2017, technical problems were highlighted.…”

Section: Main Sectionsmentioning

confidence: 99%

Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology – A Review

Radkowski,

Barańska,

Mieszkowski

et al. 2024

IJGM

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The administration of general anesthesia is a crucial aspect of surgery. However, it can pose significant risks to patients, such as respiratory depression and prolonged neuromuscular blockade. To avoid such complications, it is essential to monitor neuromuscular transmission during anesthesia. While clinical tests have been used for decades to evaluate muscle function, they are now known to be unreliable, and relying on them increases the risk of postoperative complications. Thankfully, there are now six methods available for neuromuscular monitoring during anesthesia: mechanomyography, acceleromyography, electromyography, kinemyography, phonomyography, and compressomyography. Each of these methods differs in terms of their approach and methodology, and their importance in clinical practice varies accordingly. Mechanomyography involves measuring the mechanical response of a muscle to nerve stimulation, while acceleromyography measures the acceleration of muscle contraction. Electromyography records the electrical activity of muscles, while kinemyography tracks muscle movement. Phonomyography records the sound waves produced by contracting muscles, and compressomyography involves monitoring the pressure changes in a muscle during contraction. Overall, understanding the differences between these methods and their clinical significance is crucial for anesthesiologists. This review aims to provide an updated understanding of the current methods available for neuromuscular monitoring during anesthesia, so that anesthesiologists can make informed decisions about patient care and reduce the risk of postoperative complications.

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Neuromuscular monitoring during modified rapid sequence induction: A comparison of TOF-Cuff® and TOF-Scan®

Cited by 5 publications

References 20 publications

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia

Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology – A Review

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