The Effect of Phonomyography Prototype for Intraoperative Neuromuscular Monitoring: A Preliminary Study

Area of Science:

• Anesthesiology
• Pharmacology
• Biomedical Engineering

Background:

• Clinical guidelines recommend quantitative neuromuscular monitoring to prevent residual neuromuscular block (rNMB) after administering neuromuscular blockers (NMBs).
• Current utilization of advanced neuromuscular monitoring methods remains suboptimal worldwide.
• Phonomyography (PMG) presents potential advantages including convenience, stability, and multi-muscle recording capabilities.

Purpose of the Study:

• To conduct a feasibility analysis of a novel phonomyography (PMG) prototype.
• To evaluate the effectiveness of the PMG prototype as a neuromuscular monitoring tool under general anesthesia.
• To compare the performance of the PMG prototype against a standard monitoring device (TOF-Watch SX).

Main Methods:

• A prospective observational preliminary study involving 25 adult patients undergoing elective non-cardiac surgery.
• Simultaneous recording of neuromuscular monitoring data using the PMG prototype and TOF-Watch SX at the adductor pollicis.
• Pharmacodynamic assessment of single-bolus rocuronium administration.

Main Results:

• No statistically significant difference was observed in the time duration to achieve a 0.9 train-of-four (TOF) ratio between the PMG prototype and TOF-Watch SX (p > 0.05).
• Secondary outcome measures, including multi-temporal neuromuscular monitoring data, showed no significant differences between the two devices (p > 0.05).
• Strong correlations and good agreement were found between the PMG prototype and TOF-Watch SX across all monitoring periods, confirmed by correlation tests and Bland-Altman plots.

Conclusions:

• The PMG prototype demonstrated feasibility, security, and effectiveness as a neuromuscular monitoring technique during general anesthesia.
• The PMG prototype is interchangeable with the TOF-Watch SX for quantitative neuromuscular monitoring.
• Findings support the potential of PMG as a valuable tool to improve the safety and efficacy of neuromuscular blockade management.