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Comparison of Contralateral Acceleromyography and Electromyography for Posttetanic Count Measurement.

Hyunyoung Joo1, Sooyoung Cho2, Jong Wha Lee2

  • 1Department of Anesthesiology and Pain Medicine, Daniel Hospital, Bucheon, Republic of Korea.

Anesthesiology
|December 15, 2022
PubMed
Summary

Acceleromyography and electromyography show fair agreement for train-of-four counts but differ in posttetanic counts. Acceleromyography- and electromyography-posttetanic counts are not interchangeable for assessing neuromuscular blockade.

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Area of Science:

  • Anesthesiology
  • Clinical monitoring
  • Neuromuscular blockade assessment

Background:

  • Electromyography (EMG) offers advantages over mechanomyography and acceleromyography (AMG).
  • Previous studies indicated fair agreement between AMG and EMG for train-of-four (TOF) counts.
  • The current study aimed to evaluate the agreement of posttetanic count (PTC) and neuromuscular blockade status between AMG and EMG.

Purpose of the Study:

  • To assess the agreement of posttetanic count (PTC) between acceleromyography (AMG) and electromyography (EMG).
  • To evaluate the agreement in classifying neuromuscular blockade status (intense vs. deep block) using PTC from AMG and EMG.

Main Methods:

  • Thirty-six adult patients received rocuronium for neuromuscular blockade.
  • Train-of-four (TOF) and posttetanic counts (PTCs) were measured simultaneously using EMG and AMG in contralateral arms.
  • PTCs were recorded at 6-minute intervals until TOF count reached 1.

Main Results:

  • Percentage agreement for neuromuscular blockade status between AMG and EMG was 73% (Cohen's kappa = 0.26).
  • AMG-PTCs were frequently higher than EMG-PTCs (50% of pairs).
  • Mean EMG-PTC was 38% lower than mean AMG-PTC (P = 0.0002).

Conclusions:

  • Acceleromyography (AMG) tends to overestimate posttetanic counts (PTCs) compared to electromyography (EMG).
  • AMG and EMG-PTCs are not interchangeable for accurately assessing the degree of neuromuscular blockade.
  • Clinical decisions based on PTCs from these two methods may differ.