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Eur J Anaesthesiol. 2014 Aug;31(8):404-10. doi: 10.1097/EJA.0b013e3283645691.

Performance of acceleromyography with a short and light TOF-tube compared with mechanomyography: a clinical comparison.

Author information

1
From the Department of Anaesthesiology, University of Louvain, CHU UCL Mont-Godinne-Dinant, Yvoir (PED, JM, MG, CD), MDB Engineering, Spin-off University of Brussels ULB, Brussels (MDB), Scientific Support Unit, University of Louvain, CHU UCL Mont-Godinne-Dinant, Yvoir, Belgium (JJ), and Department of Anaesthesiology, University Hospital, Geneva, Switzerland (AH).

Abstract

BACKGROUND:

Disturbances in the thumb's movement interfere with the functioning of acceleromyography in many clinical settings. The short and light (SL) train-of-four (TOF)-Tube is a new version of a rigid tubular device that was designed to protect the thumb from external disturbances during surgery, even when the hand is not accessible by the anaesthesiologist.

OBJECTIVE:

To compare the precision and performance of acceleromyography performed with the aid of the SL TOF-Tube (AMGTT) with standard isometric mechanomyography (MMG).

DESIGN:

Simultaneous arm-to-arm comparison of both methods in the same anaesthetised patient.

SETTING:

A monocentric study, performed from September 2007 to June 2008.

PATIENTS:

Nineteen ASA I to II patients scheduled to undergo lower limb orthopaedic surgery under general anaesthesia.

INTERVENTION:

Neuromuscular transmission monitoring during baseline, onset and spontaneous recovery of rocuronium-induced neuromuscular block.

MAIN OUTCOME MEASURES:

Initial baseline and repeatability coefficients were assessed during 10 consecutive measurements of the first twitch height (T1) and TOF T4/T1 ratio and compared using a z test. The spontaneous recoveries of defined blockade levels (onset, T1 25% of initial calibration and TOF ratio 0.9) were compared in terms of duration and intensity. Agreement between both techniques was assessed by the Bland-Altman method.

RESULTS:

The mean ± SD control TOF ratios were 98 ± 1% (MMG) and 103 ± 2% (AMGTT). The repeatability coefficients were higher (P < 0.001) and the onset was longer (mean 0.44 min) (P < 0.001) when they were measured by AMGTT. The recoveries of T1 25% and TOF ratio 0.9 were not significantly different between the two methods, and the limits of agreement were in the usual range of contralateral comparisons (-19 and +24% for TOF ratio 0.9).

CONCLUSION:

Compared with mechanomyography, acceleromyography performed with the aid of an SL TOF-Tube offered acceptable precision and equivalent performance during neuromuscular block recovery.

PMID:
23884404
DOI:
10.1097/EJA.0b013e3283645691
[Indexed for MEDLINE]

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