Hostname: page-component-77c89778f8-rkxrd Total loading time: 0 Render date: 2024-07-16T15:09:57.126Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical validation of electromyography and acceleromyography as sensors for muscle relaxation

Published online by Cambridge University Press:  01 October 2007

P. Hänzi ,
D. Leibundgut ,
R. Wessendorf ,
R. Lauber  and
A. M. Zbinden
P. Hänzi
Affiliation:
University Hospital of Bern, Department of Anaesthesiology, Murtenstrasse, Bern, Switzerland
D. Leibundgut
Affiliation:
University Hospital of Bern, Department of Anaesthesiology, Murtenstrasse, Bern, Switzerland
R. Wessendorf
Affiliation:
University Hospital of Bern, †Department of Anaesthesiology, Kreiskrankenhaus Erding, Bajuwarenstrasse, Erding, Germany
R. Lauber
Affiliation:
University Hospital of Bern, Department of Anaesthesiology, Murtenstrasse, Bern, Switzerland
A. M. Zbinden
Affiliation:
University Hospital of Bern, Department of Anaesthesiology, Murtenstrasse, Bern, Switzerland
Get access

Summary

Background and objective

The aim of this study was to determine which of two clinically applied methods, electromyography or acceleromyography, was less affected by external disturbances, had a higher sensitivity and which would provide the better input signal for closed loop control of muscle relaxation.

Methods

In 14 adult patients, anaesthesia was induced with intravenous opioids and propofol. The response of the thumb to ulnar nerve stimulation was recorded on the same arm. Mivacurium was used for neuromuscular blockade. Under stable conditions of relaxation, the infusion-rate was decreased and the effects of turning the hand were investigated.

Results

Electromyography and acceleromyography both reflected the change of the infusion rate (P = 0.015 and P < 0.001, respectively). Electromyography was significantly less affected by the hand-turn (P = 0.008) than acceleromyography. While zero counts were detected with acceleromyography, electromyography could still detect at least one count in 51.1%.

Conclusions

Electromyography is more reliable for use in daily practice as it is less influenced by external disturbances than acceleromyography.

Keywords

NEUROMUSCULAR BLOCKING AGENTS, mivacuriumNEUROMUSCULAR BLOKADE, acceleromyography, electromyographyEQUIPMENT AND SUPPLIES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 882 - 888
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Viby-Mogensen, J, Engbaek, J, Eriksson, LI et al. . Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.CrossRefGoogle ScholarPubMed
2.Dahaba, AA, von Klobucar, F, Rehak, PH. The neuromuscular transmission module vs. the relaxometer mechanomyograph for neuromuscular block monitoring. Anesth Analg 2002; 94: 591–596.CrossRefGoogle Scholar
3.Viby-Mogensen, J, Jensen, NH, Engbaek, J, Ording, H, Skovgaard, LT, Chraemmer-Jorgensen, B. Tactile and visual evaluation of the response to train-of-four nerve stimulation. Anesthesiology 1985; 63: 440–443.CrossRefGoogle ScholarPubMed
4.Kopman, AF, Mallhi, MU, Justo, MD, Rodricks, P, Neuman, GG. Antagonism of mivacurium-induced neuromuscular blockade in humans. Edrophonium dose requirements at threshold train-of-four count of 4. Anesthesiology 1994; 81: 1394–1400.CrossRefGoogle ScholarPubMed
5.Kopman, AF, Klewicka, MM, Neuman, GG. The relationship between train-of-four fade and single twitch depression. Anesthesiology 2002; 96: 583–587.CrossRefGoogle ScholarPubMed
6.Hayes, AH, Mirakhur, RK, Breslin, DS, Reid, JE, McCourt, KC. Postoperative residual block after intermediate-acting neuromuscular blocking drugs. Anaesthesia 2001; 56: 312–318.CrossRefGoogle ScholarPubMed
7.Viby-Mogensen, J, Jensen, E, Werner, M, Nielsen, HK. Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand 1988; 32: 45–48.CrossRefGoogle ScholarPubMed
8.Kopman, AF. Measurement and monitoring of neuromuscular blockade. Curr opin Anesthesiol 2002; 15: 415–420.CrossRefGoogle ScholarPubMed
9.Viegas, O, Kopman, AF, Klevicka, MM. An open label, parallel group, comparative randomized multicenter trial to compare the time course of the neuromuscular effects and safety of Raplon (rapacuronium bromide) for injection and mivacurium in adults (abstract). Anesth Analg 2001; 92: 211.Google Scholar
10.Kirkegaard-Nielsen, H, Helbo-Hansen, HS, Lindholm, P, Pedersen, HS, Severinsen, IK, Schmidt, MB. New equipment for neuromuscular transmission monitoring: a comparison of the TOF-Guard with the myograph 2000. J Clin Monit Comput 1998; 14: 19–27.CrossRefGoogle ScholarPubMed
11.Dahaba, AA, Rehak, PH, List, WF. Assessment of accelerography with the TOF-GUARD: a comparison with electromyography. Eur J Anaesth 1997; 14: 623–629.CrossRefGoogle ScholarPubMed
12.Nakata, Y, Goto, T, Saito, H et al. . Comparison of acceleromyography and electromyography in vecuronium-induced neuromuscular blockade with xenon or sevoflurane anaesthesia. J Clin Anesth 1998; 10: 200–203.CrossRefGoogle ScholarPubMed
13.Engbaek, J, Mortensen, CR. Monitoring of neuromuscular transmission. Ann Acad Med Singapore 1994; 23: 558–565.Google ScholarPubMed
14.May, OP, Kirkegaard-Nielsen, H, Werner, MU. The acceleration transducer – an assessment of its precision in comparison with a force displacement transducer. Acta Anesthesiol Scand 1988; 32: 239–243.CrossRefGoogle ScholarPubMed
15.Werner, MU, Kirkegaard-Nielsen, H, May, O, Djernes, M. Assessment of neuromuscular transmission by the evoked acceleration response (an evaluation of the accuracy of the acceleration transducer in comparison with a force displacement transducer). Acta Anesthesiol Scand 1988; 32: 395–400.CrossRefGoogle ScholarPubMed
16.Harper, NJN, Martlew, R, Strang, T, Wallace, M. Monitoring neuromuscular block by acceleromyography: comparison of the Mini-Accelerograph with the Myograph 2000. Brit J Anaesth 1994; 72: 411–414.CrossRefGoogle ScholarPubMed
17.Lepage, JY, Malinovski, JM, Lechevalier, T, Cozian, A, Pinaud, M. Neuromuscular junction: neuromuscular transmission analyser: mechanomyography vs. acceleromyography. Anesthesiology 1995; 83: A891.Google Scholar
18.Loan, PB, Paxton, LD, Mirakhur, RK et al. . The TOF-Guard neuromuscular transmission monitor. A comparison with the Myograph 2000. Anaesthesia 1995; 50: 699–702.CrossRefGoogle ScholarPubMed
19.Lendl, M, Schwarz, UH, Romeiser, HJ, Unbehauen, R, Georgieff, M, Geldner, GF. Nonlinear modul-based predictive control of non-depolarizing muscle relaxants using neural networks. J Clin Monit Comput 1999; 15: 271–278.CrossRefGoogle Scholar
20.Dubois, PE, Broka, SM, Jamart, J, Joucken, KL. TOF-tube, a new protection for acceleromyography, compared with the TOF-Guard/TOF-watch arm board. Acta Anaesth Belg 2002; 53 (1): 33–38.Google ScholarPubMed
21.Elorbany, M, Wafai, Y. Electromyography and acceleromyography do not measure the same physiological event. Brit J Anaesth 2001; 86: 737–738.Google Scholar
22.Meretoja, OA, Brown, TCK. Drift of the evoked thenar EMG-signal. Anesthesiology 1989; 71: A825.CrossRefGoogle Scholar
23.Kopman, AF, Klewicka, MM, Neuman, GG. The relationship between train-of-four fade and single twitch depression. Anesthesiology 2002; 96: 583–587.CrossRefGoogle ScholarPubMed
24.Kopman, AF, Chin, W, Cyriac, J. Acceleromyography vs. electromyography: an ipsilateral comparison of the indirectly evoked neuromuscular response to train-of-four stimulation. Acta Anesthesiol Scand 2005; 49: 316–322.CrossRefGoogle ScholarPubMed