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Updated: Jul 21, 2026

Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation
07:53

Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation

Published on: September 13, 2015

Agreement between muscle movement and peripheral nerve stimulation in critically ill pediatric patients receiving

O Peña1, S Prestjohn, C E Guzzetta

  • 1Children's Medical Center of Dallas, Texas, USA.

Heart & Lung : the Journal of Critical Care
|September 15, 2000
PubMed

Insights

Clinical muscle movement assessment and train-of-four (TOF) scores show poor agreement during neuromuscular blocking agent infusions in children. Fair to substantial agreement is observed after infusions cease, highlighting the need for combined monitoring to prevent overdose.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Pharmacology

Background:

  • Neuromuscular blocking agents (NBAs) are crucial for managing mechanical ventilation in pediatric intensive care units.
  • Accurate titration of NBAs is essential to prevent prolonged muscle paralysis and associated complications.
  • Assessing neuromuscular blockade depth is challenging, necessitating reliable monitoring methods.

Purpose of the Study:

  • To evaluate the agreement between clinical observation of muscle movement and train-of-four (TOF) scores during and after NBA infusions in children.
  • To determine the reliability of these methods for guiding NBA titration in pediatric patients.

Main Methods:

  • A method-comparison study was conducted in a pediatric intensive care unit.
  • Twenty-seven children receiving NBA infusions were included.
  • Outcome measures involved clinical assessment of muscle movement and TOF monitoring via peripheral nerve stimulation.

Main Results:

  • Poor agreement (kappa < 0.30) was observed between clinical assessment and TOF scores during NBA infusions.
  • Fair to substantial agreement (kappa 0.34–0.70) was found between the two methods after infusion discontinuation.
  • Significant discrepancies highlight challenges in real-time neuromuscular blockade assessment.

Conclusions:

  • Clinical endpoints for paralysis and TOF monitoring show limited agreement during NBA infusions in children.
  • Post-infusion assessment demonstrates better concordance between methods.
  • Nurses should integrate both clinical observation and TOF stimulation for precise NBA titration to avoid overdose and prolonged paralysis.
Abstract

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