Search Results (3)

Background/Objectives: Current guidelines recommend objective neuromuscular monitoring to ensure patient safety during neuromuscular blockade. Acceleromyography using train-of-four (TOF) stimulation is most commonly used to assess neuromuscular function. This study compares a new electromyography-based monitor with an established acceleromyography device for neuromuscular monitoring when mounted on a restricted arm. Methods: This prospective, controlled observational study enrolled patients undergoing surgery with general anesthesia requiring neuromuscular blockade. Two neuromuscular monitoring systems were used simultaneously: the standard acceleromyography device (Philips IntelliVue MX550) and the electromyography-based TetraGraph^® monitor on the opposite arm. Atracurium was administered as the neuromuscular blocking agent. The TetraGraph^® arm was restricted during surgery. The primary outcome was the time for the TOF ratio to return to ≥90%. Secondary endpoints included the time to reach a TOF count of 0 during induction. Data were analyzed using Bland–Altman plots and a paired t-test. Results: Mean time to recovery to TOF ratio ≥ 90% was 67 min (±21.4) for IntelliVue MX 550 and 75.8 min (±22.3) for TetraGraph^® (p = 0.0001; mean bias 8.9 min, 95% confidence intervals (CIs) 5.99–11.8). The mean time to reach a TOF count of 0 was 180.6 s (±7.8) for IntelliVue and 200 s (±8.2) for TetraGraph^® (p = 0.0217; mean bias 19 s, 95% CI 2.96–35.8). Conclusions: TetraGraph^® consistently recorded the endpoints later than IntelliVue, reflecting slower onset and recovery times. However, substantial intra-individual variability was observed with both devices during recovery from neuromuscular block. The observed differences may have clinical implications, such as when assessing readiness for extubation. Full article

Neuromuscular blocking agents such as atracurium and rocuronium are commonly used during anesthetic procedures in laboratory pigs. However, species-specific dosing guidelines remain limited, leading to reliance on data extrapolated from other species. This prospective, blinded study aimed to determine the equipotent dose for atracurium (A) and rocuronium (R) in laboratory pigs receiving propofol and to compare their cost-effectiveness. Twelve healthy animals were randomly distributed according to the drug administered (n = 6 per group). For both drugs, the infusion rate was adjusted following an up-and-down titration to maintain a train-of-four count between 3 and 4. Group differences were analyzed using the Wilcoxon signed-rank test. The bolus induction dose (mg/kg) was comparable between atracurium (2.3 [1.8–2.6]) and rocuronium (2 [2]), while atracurium was associated with higher costs (CHF/kg: A, 1.122 [0.878–1.366] versus R, 0.208 [0.208–0.208]; p = 0.002725). The maintenance infusion rate (mg/kg/h) was approximately 40% lower for atracurium (2.7 [2.5–2.8]) than for rocuronium (4.5 [4.4–4.5]; p = 0.004922), yet the maintenance cost (CFH/kg/h) remained higher for atracurium (A: 1.30 [1.22–1.37] versus R: 0.47 [0.45–0.47]; p = 0.0043). This study reports higher doses for anesthetized pigs compared to other species and demonstrates that rocuronium offers superior cost-effectiveness compared to atracurium under these experimental conditions. Full article

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability. Full article