Intraoperative Electromyographic Monitoring in Children Less Than 1 Year of Age

Despite the potential to improve patient outcomes, quantitative train-of-four (TOF) monitoring has seen limited use in infants and children primarily due to the lack of effective equipment. The current study investigates the feasibility of using an electromyography-based TOF monitor (TetraGraph) in patients < 1 year of age.

Following informed consent, patients < 1 year of age presenting for elective surgery that required use of a non-depolarizing neuromuscular blocking agent were enrolled. The TetraGraph electrodes were positioned on the volar aspect of the forearm over the ulnar nerve to supply neurostimulation. Muscle action potentials were recorded at 20-s intervals from the adductor pollicis muscle throughout surgery until tracheal extubation. Data from the monitor were recorded onto the built-in memory card.

The study cohort included 49 patients ranging in age from 30 days to 10 months and in weight from 3.1 to 10.3 kg. Effective monitoring was achieved in all 49 patients in the cohort. Based on our clinical practice, rocuronium was the neuromuscular blocking agent used in all patients. Complete data of neuromuscular recording (baseline to recovery) was obtained in 36 patients, as a complete baseline was not obtained in two patients, and 11 patients either did not receive sugammadex based on clinical need or the sensor was removed prior to recovery. Baseline amplitude for muscle action potential was 6.8 ± 2.2 mV and recovered to 4.7 ± 1.5 mV after reversal of neuromuscular block with sugammadex at completion of the case. The mean baseline TOFr was 99% ± 16.3% and the mean recovered TOFr was 95% ± 10%.

In patients > 28 days and < 1 year of age, our preliminary data suggest that electromyography-based TOF monitoring can be used effectively.