背景:定量监测神经肌肉阻断剂给药后神经肌肉阻滞水平的可靠装置至关重要。肌电图和加速肌电图是临床实践中常用的两种监测方式。这项研究的主要结果是比较神经肌肉阻滞的发作,定义为由基于肌电图的设备(TetraGraph)和基于加速肌电图的设备(TOFscan)测量的等于0的四组计数(TOFC)。次要结果是当这两个装置中的一个达到等于0的TOFC时比较插管条件。
方法:招募了100名需要神经肌肉阻滞的择期手术的成年患者。麻醉诱导前,根据随机化将TetraGraph电极放置在患者的优势/非优势手的前臂上,并将TOFscan电极放置在对侧前臂上。术中神经肌肉阻断剂剂量标准化为0.5mg。kg-1的罗库溴铵。获得基线值后,每20秒记录一次客观测量值,一旦任一装置显示TOFC=0,则使用视频喉镜进行插管.然后对麻醉提供者进行了有关插管条件的调查。
结果:基线TetraGraph四序列比率高于使用TOFscan获得的比率(中位数:1.02[0.88,1.20]与1.00[0.64,1.01],分别,p<0.001)。与TOFscan相比,使用TetraGraph测量时达到TOFC=0的时间明显更长(中位数:160[40,900]与120[60,300]秒,分别,p<0.001)。当使用任一设备确定气管内插管的时机时,插管条件没有显着差异。
结论:用TetraGraph测量时,神经肌肉阻滞的发作时间长于TOFscan,在任何一种设备中,四个计数为零是适当插管条件的有用指标。
背景:URLNCT05120999,https://clinicaltrials.gov/ct2/show/NCT05120999。
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.
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.
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.
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.
URL NCT05120999, https://clinicaltrials.gov/ct2/show/NCT05120999.