Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial
Background: Reliable devices that quantitatively monitor the level of neuromuscular blockade after neuromuscular blocking agents’ administration are crucial. Electromyography and acceleromyography are two monitoring modalities commonly used in clinical practice. The primary outcome of this study is...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001423000301 |
| _version_ | 1797786596664147968 |
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| author | Harold E. Chaves-Cardona Eslam A. Fouda Vivian Hernandez-Torres Klaus D. Torp Ilana I. Logvinov Michael G. Heckman Johnathan Ross Renew |
| author_facet | Harold E. Chaves-Cardona Eslam A. Fouda Vivian Hernandez-Torres Klaus D. Torp Ilana I. Logvinov Michael G. Heckman Johnathan Ross Renew |
| author_sort | Harold E. Chaves-Cardona |
| collection | DOAJ |
| description | Background: Reliable devices that quantitatively monitor the level of neuromuscular blockade after neuromuscular blocking agents’ administration are crucial. Electromyography and acceleromyography are two monitoring modalities commonly used in clinical practice. The primary outcome of this study is to compare the onset of neuromuscular blockade, defined as a Train-Of-Four Count (TOFC) equal to 0, as measured by an electromyography-based device (TetraGraph) and an acceleromyography-based device (TOFscan). The secondary outcome was to compare intubating conditions when one of these two devices reached a TOFC equal to 0. Methods: One hundred adult patients scheduled for elective surgery requiring neuromuscular blockade were enrolled. Prior to induction of anesthesia, TetraGraph electrodes were placed over the forearm of patients’ dominant/non-dominant hand based on randomization and TOFscan electrodes placed on the contralateral forearm. Intraoperative neuromuscular blocking agent dose was standardized to 0.5 mg.kg−1 of rocuronium. After baseline values were obtained, objective measurements were recorded every 20 seconds and intubation was performed using video laryngoscopy once either device displayed a TOFC = 0. The anesthesia provider was then surveyed about intubating conditions. Results: Baseline TetraGraph train-of-four ratios were higher than those obtained with TOFscan (Median: 1.02 [0.88, 1.20] vs. 1.00 [0.64, 1.01], respectively, p < 0.001). The time to reach a TOFC = 0 was significantly longer when measured with TetraGraph compared to TOFscan (Median: 160 [40, 900] vs. 120 [60, 300] seconds, respectively, p < 0.001). There was no significant difference in intubating conditions when either device was used to determine the timing of endotracheal intubation. Conclusions: The onset of neuromuscular blockade was longer when measured with TetraGraph than TOFscan, and a train-of-four count of zero in either device was a useful indicator for adequate intubating conditions. Clinical trial number and registry: URL NCT05120999, https://clinicaltrials.gov/ct2/show/NCT05120999. |
| first_indexed | 2024-03-13T01:11:05Z |
| format | Article |
| id | doaj.art-ca1d980f74e64e79970234ca6cf3afed |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-03-13T01:11:05Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-ca1d980f74e64e79970234ca6cf3afed2023-07-06T04:17:00ZengElsevierBrazilian Journal of Anesthesiology0104-00142023-07-01734393400Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trialHarold E. Chaves-Cardona0Eslam A. Fouda1Vivian Hernandez-Torres2Klaus D. Torp3Ilana I. Logvinov4Michael G. Heckman5Johnathan Ross Renew6Mayo Clinic Jacksonville, Department of Anesthesiology and Perioperative Medicine, Florida, USAMayo Clinic Jacksonville, Department of Anesthesiology and Perioperative Medicine, Florida, USAMayo Clinic Jacksonville, Department of Anesthesiology and Perioperative Medicine, Florida, USAMayo Clinic Jacksonville, Department of Anesthesiology and Perioperative Medicine, Florida, USAMayo Clinic Jacksonville, Department of Anesthesiology and Perioperative Medicine, Florida, USAMayo Clinic Jacksonville, Division of Clinical Trials and Biostatistics, Florida, USAMayo Clinic Jacksonville, Department of Anesthesiology and Perioperative Medicine, Florida, USA; Corresponding author.Background: Reliable devices that quantitatively monitor the level of neuromuscular blockade after neuromuscular blocking agents’ administration are crucial. Electromyography and acceleromyography are two monitoring modalities commonly used in clinical practice. The primary outcome of this study is to compare the onset of neuromuscular blockade, defined as a Train-Of-Four Count (TOFC) equal to 0, as measured by an electromyography-based device (TetraGraph) and an acceleromyography-based device (TOFscan). The secondary outcome was to compare intubating conditions when one of these two devices reached a TOFC equal to 0. Methods: One hundred adult patients scheduled for elective surgery requiring neuromuscular blockade were enrolled. Prior to induction of anesthesia, TetraGraph electrodes were placed over the forearm of patients’ dominant/non-dominant hand based on randomization and TOFscan electrodes placed on the contralateral forearm. Intraoperative neuromuscular blocking agent dose was standardized to 0.5 mg.kg−1 of rocuronium. After baseline values were obtained, objective measurements were recorded every 20 seconds and intubation was performed using video laryngoscopy once either device displayed a TOFC = 0. The anesthesia provider was then surveyed about intubating conditions. Results: Baseline TetraGraph train-of-four ratios were higher than those obtained with TOFscan (Median: 1.02 [0.88, 1.20] vs. 1.00 [0.64, 1.01], respectively, p < 0.001). The time to reach a TOFC = 0 was significantly longer when measured with TetraGraph compared to TOFscan (Median: 160 [40, 900] vs. 120 [60, 300] seconds, respectively, p < 0.001). There was no significant difference in intubating conditions when either device was used to determine the timing of endotracheal intubation. Conclusions: The onset of neuromuscular blockade was longer when measured with TetraGraph than TOFscan, and a train-of-four count of zero in either device was a useful indicator for adequate intubating conditions. Clinical trial number and registry: URL NCT05120999, https://clinicaltrials.gov/ct2/show/NCT05120999.http://www.sciencedirect.com/science/article/pii/S0104001423000301AccelerometryElectromyographyIntubationNeuromuscular blockadeNeuromuscular junctionIntraoperative neurophysiological monitoring |
| spellingShingle | Harold E. Chaves-Cardona Eslam A. Fouda Vivian Hernandez-Torres Klaus D. Torp Ilana I. Logvinov Michael G. Heckman Johnathan Ross Renew Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial Brazilian Journal of Anesthesiology Accelerometry Electromyography Intubation Neuromuscular blockade Neuromuscular junction Intraoperative neurophysiological monitoring |
| title | Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial |
| title_full | Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial |
| title_fullStr | Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial |
| title_full_unstemmed | Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial |
| title_short | Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial |
| title_sort | comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring a prospective clinical trial |
| topic | Accelerometry Electromyography Intubation Neuromuscular blockade Neuromuscular junction Intraoperative neurophysiological monitoring |
| url | http://www.sciencedirect.com/science/article/pii/S0104001423000301 |
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