Quantitative Neuromuscular Monitoring: Current Devices, New Technological Advances, and Use in Clinical Practice

A Comparison Between the Adductor Pollicis Muscle Using TOF-Watch SX and the Abductor Digiti Minimi Muscle Using TetraGraph in Rocuronium-Induced Neuromuscular Block: A Prospective Observational Study

“…It is well known that TOFR often exceeds 100%, termed the “reverse fade” when using AMG. 2 Moreover, comparison between baseline and final TOFR was significantly different with TOF-Watch SX, but not with TetraGraph. Our result suggests that TetraGraph may be a better indicator for adequate recovery than TOF-Watch SX according to the higher and more variable baseline TOFR with AMG than EMG.…”

“…EMG enables measurement without the limitations of AMG such as requiring free movement of the thumb, complete immobilization of the arm, appropriate preload on the thumb, stabilization of the responses, and normalization of the results to obtain a reliable measurement. 1,2 However, little is known about the comparison between AMG-based TOF-Watch SX and EMG-based neuromuscular monitor TetraGraph. Although an ipsilateral comparison of AP muscle/ulnar nerve configuration between TOF-Watch SX and TetraGraph was recently reported, 3,4 the comparison in measurement of the recovery time to profound neuromuscular block and moderate neuromuscular block, which have important implications for the decision of the adequate reversal dose of sugammadex, has not been reported.…”

Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial

“…Objective (quantitative) neuromuscular monitoring allows for accurate neuromuscular evaluation compared to the subjective techniques with a peripheral nerve stimulator. 6 Electromyography (EMG) and Acceleromyography (AMG) are the two of the more commonly used quantitative monitoring modalities used in clinical practice. While the utility of such monitors has been demonstrated with confirming adequate recovery and avoiding residual weakness, these devices can also be used to identify when optimal intubating conditions have been reached.…”