Peripheral nerve stimulator performance: The influence of output polarity and electrode placement

Rosenberg, Henry; De, Greenhow

doi:10.1007/bf03006574

Cited by 18 publications

(5 citation statements)

References 3 publications

(1 reference statement)

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“…In the monopolar configuration, the depolarising (negative) electrode is placed distally 1 cm proximal to the wrist crease on the radial side of the flexor carpi ulnaris, while another is placed proximally on the volar forearm as shown in Fig. . This orientation ensures maximal neuronal stimulation and muscular response (Fig.…”

Section: Where Should We Monitor?mentioning

confidence: 99%

Conceptual and technical insights into the basis of neuromuscular monitoring

2017

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Summary Unrecognised postoperative residual neuromuscular block remains a frequent occurrence in recovery rooms. Evidence indicates that current practice continues to perpetuate the status quo, in which 10–40% of patients experience postoperative residual weakness. A departure from the current practice requires small efforts on the clinicians’ part. This review addresses several selected core questions regarding neuromuscular blockade monitoring and provides a framework to rationally discuss and develop basic guidelines for the use of neuromuscular blocking agents in patient care.

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Section: Where Should We Monitor?mentioning

confidence: 99%

Conceptual and technical insights into the basis of neuromuscular monitoring

2017

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“…A 2–3.5 mA output will evoke a motor response in most superficial nerves in young children when stimulated in this manner. Reversing the polarity increases the current required to evoke a positive response approximately two‐ to fourfold (14–17). Higher currents should be avoided because they can depolarize nerves distant from the exploring electrode.…”

Section: Discussionmentioning

confidence: 99%

“…Both can be modified for the purpose of nerve mapping. Ideally, the nerve stimulator should deliver a low constant current output, pulse width 50–100 μs, which can be adjusted linearly between 0 and 10 mA delivered at 0.5–2 Hz (5,17). A digital display of the current output is an advantage but should not preclude its use.…”

Section: Discussionmentioning

confidence: 99%

Surface mapping of peripheral nerves in children with a nerve stimulator

Bosenberg

Raw²,

Boezaart

2002

Pediatric Anesthesia

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Defining anatomical landmarks may be difficult in the growing child. With the aid of a peripheral nerve stimulator, the path of many superficial peripheral nerves can be 'mapped' prior to skin penetration by stimulating the motor component of the peripheral nerve percutaneously with a 2-3.5 mA output. The required current will vary and is dependent upon the depth of the nerve and the moistness of the overlying skin. This 'nerve mapping technique' has proved particularly useful for brachial plexus, axillary, ulna and median nerve blocks in the upper limb and femoral and popliteal nerve blocks in the lower limb. It is a useful teaching tool and improves the success rate of peripheral nerve blocks in children of all ages.

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“…Los ensayos se realizaron mediante la estimulación de los nervios mediano y cubital (12), y se registró la respuesta cinética del dedo pulgar. El empleo de electrodos con dimensiones reducidas y su colocación sobre el trayecto aproximado de los nervios, tiene la finalidad de aplicar selectivamente el estímulo eléctrico.…”

Section: Procedimiento Experimentalunclassified

“…En el proceso de calibración, se empleó una intensidad de corriente eléctrica de 50 mA como mínimo (6,7,12). Durante las etapas de inducción y recuperación (o reversión) de la relajación muscular, el monitor se configuró para monitorización automática cada 15 segundos; y durante el acto quirúrgico, cada 2 minutos.…”

Section: Procedimiento Experimentalunclassified

Ensayos en Ambiente Hospitalario de Técnicas de Monitorización de Bloqueo Neuromuscular: Resultados Preliminares

Viaña¹,

Fernández²,

Escobar

et al. 2014

Ciencia e Innovación en Salud

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RESUMENIntroducción: La respuesta de grupos musculares a consecuencia de la estimulación de nervios periféricos, permite a los anestesiólogos evaluar la profundidad del bloqueo neuromuscular durante la anestesia general. Objetivo: Evaluar en la práctica médica el prototipo de un monitor cubano de bloqueo neuromuscular y sus algoritmos, para calcular indicadores objetivos de relajación muscular. Materiales y métodos: Se escogieron cirugías de corta duración y se monitorizó la función neuromuscular intraoperatoria de pacientes. Los ensayos se realizaron a partir de la estimulación de los nervios mediano y cubital con el patrón Train-of-Four (TOF) a intensidad de corriente supramáxima, registrándose la respuesta cinética del dedo pulgar y calculando automáticamente los indicadores de relajación muscular. El protocolo fue aprobado por el Consejo Científico y el Comité de Ética del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", en el marco de un proyecto de investigación conjunta entre el ICID -Tecnología Médica Digital y el Hospital. Resultados: Se presenta evidencia de la monitorización de cinco casos reales, para los que se construyeron gráficos del comportamiento en el tiempo de los indicadores de relajación muscular. El monitor sometido a ensayos se mantuvo funcionando de forma estable durante todos los actos quirúrgicos. Conclusión: A criterio de los especialistas involucrados, los indicadores de relajación muscular registrados durante los ensayos mostraron significativa correspondencia con la clínica de los pacientes, lo que proporciona evidencias a favor de las técnicas de monitorización implementadas.Palabras Clave:Bloqueo neuromuscular, relajación muscular, monitorización intraoperatoria(Fuente: DeCS). ABSTRACTIntroduction: In order to evaluate the magnitude of neuromuscular blocking during anesthesia, the anesthesiologists consider the muscular response to peripheral nerves stimulation. Objective: Study aims to calculate muscle relaxation indicators, through neuromuscular blocking and its algorithms using a Cuban made monitoring device during the medical procedure. Materials and methods: Thumb kinetic response and muscles relaxation indicators were registered and calculated automatically; for this purpose, median and nerves trials using Troin-of -Four (TOF) were conducted in shorter surgeries, which allowed to monitor patients' neuromuscular, intraoperative function. Scientific consel and the Committee of Ethics of the Clinical Surgical Hospital "HermanosAmeijeiras" approved the protocol, based on a research project conducted by the ICID -Medical Digital technology and the Hospital. Results: the monitoring was stable during all medical procedures as indicated on graph data obtained during five sample cases indicating muscle relaxation indicators. Conclusion: muscle relaxation indicators registered during trials showed significant relevance relation to patient's clinical history, giving support to evidence of the monitoring implemented techniques based on specialists' criteria.

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Peripheral nerve stimulator performance: The influence of output polarity and electrode placement

Cited by 18 publications

References 3 publications

Conceptual and technical insights into the basis of neuromuscular monitoring

Conceptual and technical insights into the basis of neuromuscular monitoring

Surface mapping of peripheral nerves in children with a nerve stimulator

Ensayos en Ambiente Hospitalario de Técnicas de Monitorización de Bloqueo Neuromuscular: Resultados Preliminares

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