Related Experiment Videos
Acceleromyography improves detection of residual neuromuscular blockade in children
J M Ansermino1, P M Sanderson, J C Bevan
1Department of Anaesthesia, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Acceleromyography (AMG) better detects residual neuromuscular blockade than visual assessment. AMG provides similar recovery estimates to electromyography (EMG), making it a valuable tool for monitoring patients.
Area of Science:
- Anesthesiology
- Pharmacology
- Clinical Monitoring
Background:
- Neuromuscular blockade is common in anesthesia.
- Accurate monitoring of neuromuscular recovery is crucial for patient safety.
- Residual neuromuscular blockade can lead to postoperative complications.
Purpose of the Study:
- To evaluate if acceleromyography (AMG) improves detection of residual neuromuscular blockade compared to visual assessment.
- To compare AMG measurements with electromyography (EMG) during neuromuscular blockade recovery.
Main Methods:
- Prospective, randomized, double-blind study involving 22 anesthetized children recovering from vecuronium blockade.
- Simultaneous measurement of neuromuscular function using EMG and AMG via train-of-four (TOF) stimulation.
- Comparison of AMG and EMG data with clinical observations of thumb twitches and TOF fade.
Main Results:
- Clinical fade resolved earlier (38.6 min) than AMG detection of the first twitch.
- Time to a TOF ratio >= 0.7 was similar for both AMG (49.1 min) and EMG (50.9 min).
- Bias between AMG and EMG was minimal (1 minute), with wide limits of agreement (-10 to 9 min).
Conclusions:
- Acceleromyography is superior to visual assessment for detecting residual neuromuscular blockade.
- AMG offers comparable estimates of neuromuscular recovery to the more complex EMG.
- AMG is a practical and effective tool for monitoring neuromuscular blockade reversal.
Purpose:
To determine whether detection of residual blockade is improved by using the accelerograph. A secondary objective was to compare acceleromyographic measurements with those obtained by electromyography.
Methods:
In a prospective, randomized, double-blind investigation, 22 anaesthetized children were studied during recovery from neuromuscular blockade following 0.1 mg.kg-1 vecuronium i.v.. Assessments of depth of block began 10 min after injection and were repeated at one minute intervals using electromyography (Datex, Relaxograph) in one hand, and acceleromyography (Biometer, Tofguard) in the other, to measure response of the adductor pollicis to train-of-four (TOF) stimulation of the ulnar nerve. Monitoring was stopped when no fade was visible and TOF ratio > or = 0.7. The electromyographic (EMG) and acceleromyographic (AMG) data were compared with corresponding observations of the number of twitches and TOF fade in the visible responses of the thumb, made by the attending anaesthetist. The method of Bland and Altman was used to compare differences between AMG and EMG data.
Results:
During recovery from neuromuscular blockade, fade was no longer visible clinically 38.6 +/- 10.4 min (mean +/- SD) after the administration of vecuronium. This corresponded to TOF ratios of 0.04 +/- 0.23 by AMG and 0.34 +/- 0.21 by EMG. Usually, two twitches were visible before AMG detected the first twitch. The time to TOF ratio > or = 0.7 by AMG and EMG was similar at 49.1 +/- 10.5 and 50.9 +/- 9.0 min, respectively. The bias between AMG and EMG was one minute, with limits of agreement from -10 to nine min.
Conclusion:
AMG is superior to visual assessment in detecting residual neuromuscular block and provides similar estimates of recovering block as the more cumbersome EMG.