Abstract
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 iv. 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 responses 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 ≥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 0.40 ± 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 ≥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.
Résumé
Objectifs
Déterminer si l’accélérographie améliore la détection de la curarisation résiduelle. Un deuxième objectif consistait à comparer les données accéléromyographique à celles de l’électromyographie.
Méthodes
Vingt-deux enfants anesthésiés qui avaient reçu vecuronium 0,1 mg· kg−1 iv ont pris part à cette étude aléatoire, prospective et en double aveugle. Dans le but de mesurer les réponses de l’adducteur du pouce au TOF du nerf cubital, l’évaluation de la profondeur de la curarisation a été débutée 10 min après l’injection et été répétée à toutes les minutes à l’aide d’un accélérographe (Biometer, Tofguard) sur une main et une stimulation au train-de-quatre (TOF) sur l’autre. Le monitorage a été arrêté au moment où l’affaiblissement de la réponse (fade) est disparu et où la relation TOF ≥0,7. L’anesthésiste responsable a comparé les données électromyographiques (EMG) et accéléromyographiques (AMG) en observant au niveau du pouce le nombre de twitches et l’affaiblissement de la réponse. La méthode de Bland et Altman a été utilisée pour comparer les différences entre les données AMG et EMG.
Résultats
Pendant la récupération, l’affaiblissement n’était pas visuellement détectable 38,6 ± 10,4 min (moyenne ± ET) après l’administration du vécuronium. Ceci correspondait à des rapports TOF de 0,40 ± 0,23 mesurés par AMG et 0,34 ± 0,21 par EMG. En général, deux twitches étaient visiblesavant la détection par AMG du premier twitch. L’intervalle jusqu’au rapport TOF ≥0,7 était identique, respectivement de 49,1 ± 10,5 et 50,9 ± 9,0 min. Le biais entre AMG et EMG était de une min, avec des limites d’accord de −10 à neuf min.
Conclusion
L’AMG est supérieure à l’évaluation visuelle pour détecter la curarisation résiduelle et fournit des données comparables à celles de l’EMG lequel est plus encombrant.
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The accelerograph, TofguardINMT (Biometer International A/S, Odense, Denmark) was donated by Organon Teknika Canada Inc.
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Ansermino, J.M., Sanderson, P.M., Bevan, J.C. et al. Acceleromyography improves detection of residual neuromuscular blockade in children. Can J Anaesth 43, 589–594 (1996). https://doi.org/10.1007/BF03011772
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DOI: https://doi.org/10.1007/BF03011772