The Neuromuscular Transmission Module Versus the Relaxometer Mechanomyograph for Neuromuscular Block Monitoring

Dahaba, Ashraf A.; Klobucar, Fedor von; Rehak, Peter; List, W. F.

doi:10.1097/00000539-200203000-00021

Cited by 48 publications

(28 citation statements)

References 9 publications

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“…7 Two EKG electrodes were placed on the patient's wrist at the ulnar nerve, and the evoked muscle response at the adductor pollicis (AP) muscle was measured by the displacement of the probe positioned between the patient's thumb and forefinger. After automatic calibration, supramaximal TOF stimulation ([ 50 mA) was applied every 15 sec, and TOF ratio (TOFR) values were displayed on the monitor screen.…”

Section: Clinical Featuresmentioning

confidence: 99%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We report a case that involved immediate postoperative respiratory failure necessitating tracheal intubation, which was possibly related to recurarization after sugammadex reversal. Clinical findings A 54-yr-old woman weighing 115-kg was scheduled for laparoscopic repair of abdominal dehiscence under general anesthesia. Muscle relaxation was induced and maintained with rocuronium (170 mg iv total dose). At the end of the 170-min procedure, two twitches were visualized after supramaximal train-of-four (TOF) stimulation at the adductor pollicis muscle, and the patient's central core temperature was 35.6°C. Sugammadex 200 mg iv (1.74 mgÁkg -1 ) was administered. With the patient fully awake, a TOF ratio 0.9 was obtained five minutes later. The tracheal tube was then removed, and the patient was transferred to the postanesthesia care unit. Ten minutes later, the patient presented respiratory failure necessitating tracheal intubation and sedation with propofol. One TOF response only was visualized at the adductor pollicis muscle. Another dose of sugammadex 200 mg iv was administered. Forty-five minutes later, the patient was fully awake and her trachea was extubated after repeated measures of the TOF ratio (C 0.9) at the adductor pollicis muscle. The patient fully recovered without sequelae, further complication, or prolonged hospital stay. Conclusion Shortly after tracheal extubation, an obese patient experienced respiratory failure necessitating tracheal intubation and an additional dose of sugammadex. This occurred despite initial reversal of neuromuscular blockade with an appropriate dose of sugammadex 2 mgÁkg -1 iv given at two responses to TOF stimulation. RésuméObjectif Nous de´crivons un cas de de´tresse respiratoire survenu en postope´ratoire imme´diat ne´cessitant l'intubation de la trache´e, possiblement lie´a`une recurarisation apre`s une de´curarisation pharmacologique avec du sugammadex. É léments cliniques Une femme de 54 ans, pesant 115 kg, e´tait programme´e pour le traitement chirurgical d'une e´ventration de la paroi abdominale par laparoscopie sous anesthe´sie ge´ne´rale. La curarisation e´tait induite et entretenue par du rocuronium (dose totale 170 mg iv). A`la fin de l'intervention, durant 170 min, deux re´ponses e´taient visualise´es apre`s une stimulation supra-maximale par un train-de-quatre (Td4) a`l'adducteur du pouce, et la tempe´rature centrale e´tait de 35,6°C. Une dose de 200 mg iv de sugammadex (1,74 mgÁkg -1 ) a e´te´administre´e pour la de´curarisation pharmacologique. Un rapport de Td4 a`0,9 al 'adducteur du pouce e´tait obtenu cinq minutes plus tard permettant le retrait de la sonde d'intubation et le transfert en salle de re´veil, la patiente re´pondant aux ordres simples. Dix minutes plus tard, elle pre´sentait une de´tresse respiratoire ne´cessitant l'intubation de la trache´e et une se´dation au propofol. Une seule re´ponse e´tait visualise´e au Td4 a`l'adducteur du pouce. Une dose supple´mentaire de 200 mg iv de sugammadex a e´te´administre´e. Quarante-cinq

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Section: Clinical Featuresmentioning

confidence: 99%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

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“…Dahaba et al 3 compared KMG and MMG for monitoring NMB in 20 patients after rocuronium 0.6 mg·kg -1 . They found that although both methods showed good agreement to determine recovery to TOF-ratio of 0.8, KMG lagged behind in determining the full course of recovery.…”

Section: Discussionmentioning

confidence: 99%

“…They found that although both methods showed good agreement to determine recovery to TOF-ratio of 0.8, KMG lagged behind in determining the full course of recovery. However, Dahaba et al 3 did not determine the course of recovery by using different TOF-ratios, but recovery to different levels of first twitch heights. This might highlight differences between the two methods more than when recovery is determined by using different TOF-ratios as done in the current study -and in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…3 Data were compared between all methods using an ANOVA for multiple comparisons, P < 0.05 was considered significant (SPSS software, SPSS Inc., Chicago, IL, USA). Lin's concordance correlation coefficient (α c ) was determined at all time periods for two methods each 12 and presented with the lower onesided 95% confidence limit (GenSTAT software, VSN International Ltd., Herts, UK).…”

Section: Methodsmentioning

confidence: 99%

“…Some studies have shown that its agreement with MMG for scientific purposes might be limited with unacceptably wide limits of agreement; 2 in clinical circumstances it can be used reasonably well to detect time to tracheal intubation and recovery of neuromuscular block (NMB). 2,3 However, the device can only be applied to measure NMB at the adductor pollicis muscle and there is only one size of the moulded probe.…”

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confidence: 99%

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Comparison of phonomyography, kinemyography and mechanomyography for neuromuscular monitoring

Trager

Michaud

Deschamps

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:The gold standard of neuromuscular monitoring is mechanomyography (MMG). Phonomyography (PMG) and kinemyography (KMG) are new methods of neuromuscular monitoring. In this study, all three methods were compared to determine neuromuscular blockade at the adductor pollicis muscle.Methods: In 14 patients, phonomyography was recorded via a microphone taped to the thenar region. A standard mechanomyographic device was applied to the same thumb, and attached to the force transducer. On the contralateral side, a NMT-Mechanosensor® probe was attached to the thumb and forefinger (KMG). After induction of general anaesthesia, the ulnar nerves were stimulated supramaximally using superficial electrodes at the wrists using train-of-four (TOF) stimulation every 12 sec. Onset and recovery indices measured by the three methods after mivacurium 0.2 mg·kg -1 iv were compared using ANOVA-multiple group comparisons. Agreement between methods was determined using Lin's concordance correlation coefficient.Results: Onset time and peak effect measured via MMG and PMG were similar. Recovery times from neuromuscular blockade (NMB) as measured via the three methods were not different. Agreement between PMG and MMG was excellent for onset and offset of NMB but unsatisfactory for peak effect. Agreement between MMG and KMG was satisfactory for TOF 0.25 and 0.50, and excellent for TOF 0.75 and 0.90 (onset and peak effect not determined for KMG). Agreement between PMG and KMG was satisfactory for TOF 0.25, 0.50 and 0.75, and excellent for TOF 0.90. Conclusion:Mechanomyography, PMG and KMG show satisfactory agreement for determination of recovery of NMB for clinical purposes. Objectif : La référence en monitorage neuromusculaire est la mécanomyographie (MMG). La phonomyographie (PMG) et la cinémyographie (CMG) sont de nouvelles méthodes. Nous comparons les trois méthodes pour qualifier le blocage neuromusculaire à l'adducteur du pouce. Méthode : La phonomyographie a été enregistrée par un microphone fixé à la région thénar chez 14 patients. Un appareil de mécanographie standard, au même pouce, a été fixé au transducteur de force. Au côté opposé, une sonde de NMTMechanosensor® a été fixée au pouce et à l'index (CMG). Après l'induction de l'anesthésie, les nerfs cubitaux ont reçu une stimulation supramaximale, utilisant un train-de-quatre (TDQ) toutes les 12 sec, produite par des électrodes superficielles aux poignets. Les indices du début et de la fin du bloc, mesurés par les trois méthodes après l'administration iv de

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Grundlagen des neuromuskulären Monitorings

Neuromuskuläres Monitoring in Klinik Und Forschung

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The Neuromuscular Transmission Module Versus the Relaxometer Mechanomyograph for Neuromuscular Block Monitoring

Cited by 48 publications

References 9 publications

Recurarization after sugammadex reversal in an obese patient

Recurarization after sugammadex reversal in an obese patient

Comparison of phonomyography, kinemyography and mechanomyography for neuromuscular monitoring

Grundlagen des neuromuskulären Monitorings

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