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Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation
Published on: September 13, 2015
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Reliability of submaximal stimulation for the train-of-four test using acceleromyography and electromyography with
Gi Year Lee1, Sooyoung Cho2,3, Hee Jung Baik1,4
1Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Republic of Korea.
Journal of Clinical Monitoring and Computing
|October 20, 2022
Summary
Submaximal stimulation in the train-of-four (TOF) test is reliable and reduces patient pain. Researchers recommend using 70% supramaximal stimulation (SMS) for TOF testing to balance reliability and comfort.
Area of Science:
- Anesthesiology
- Neuromuscular monitoring
Background:
- The train-of-four (TOF) test is crucial for assessing neuromuscular blockade during anesthesia.
- Supramaximal stimulation (SMS) used in TOF testing can cause significant patient discomfort.
Purpose of the Study:
- To evaluate the reliability of submaximal stimulation (SMS) in TOF testing.
- To determine if reduced stimulation intensity can decrease patient-reported pain.
Main Methods:
- TOF tests were performed at four stimulation intensities (100%, 70%, 50%, 30% SMS) using accelomyography (AMG) and electromyography (EMG) at extubation.
- Tests were repeated in the postanesthesia care unit (PACU) with EMG only, recording pain scores (NRS).
Main Results:
- TOF ratios showed no significant difference between SMS and lower intensities.
- Lower intensities (30%, 50% SMS) resulted in more unmeasurable tests in the PACU.
- Pain scores (NRS) were significantly lower at 50% and 30% SMS compared to 100% SMS.
Conclusions:
- Submaximal stimulation in TOF testing is reliable and reduces pain.
- 70% SMS is suggested as the minimal current for TOF testing to balance reliability and patient comfort.
Keywords:
ElectromyographyGeneral anesthesiaNeuromuscular blockadeNeuromuscular monitoringSubmaximal stimulusSupramaximal stimulusMore Related Videos
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