Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-19T10:20:09.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Acceleromyography in neonates and small infants: baseline calibration and recovery of the responses after neuromuscular blockade with rocuronium

Published online by Cambridge University Press:  13 April 2005

J. J. Driessen ,
E. N. Robertson  and
L. H. D. J. Booij
J. J. Driessen
Affiliation:
University Medical Center Nijmegen, Department of Anesthesiology, Nijmegen, The Netherlands
E. N. Robertson
Affiliation:
University Medical Center Nijmegen, Department of Anesthesiology, Nijmegen, The Netherlands
L. H. D. J. Booij
Affiliation:
University Medical Center Nijmegen, Department of Anesthesiology, Nijmegen, The Netherlands
Get access

Extract

Summary

Background: We have evaluated the use of the TOF-Guard® (TOF, train-of-four) acceleromyographic thumb responses to ulnar nerve stimulation in neonates and infants and the return of the responses after neuromuscular blockade.

Methods: Baseline acceleromyographic recording of thumb adduction to ulnar nerve stimulation during volatile anaesthesia was performed in 22 babies aged less than 30 weeks. At the start of stimulation the automatic set-up procedure of the TOF-Guard® was used to see if a 100% control twitch height could be achieved. Irrespective of the ability to achieve a 100% control twitch height, TOF stimulation was used thereafter. When no automatic 100% control twitch could be reached, the transducer signal gain factor was set manually to obtain a 100% value. In 14 of the 22 children the recovery after neuromuscular blockade with rocuronium 0.3 mg kg−1 was recorded.

Results: In nine of 22 patients a 100% baseline twitch height was obtained with the automatic set-up. In the other 13 babies the TOF-Guard® display indicated that the transducer signal was too low. The mean time to recovery of control twitch to 75% of baseline after rocuronium 0.3 mg kg−1 was 51 min (SD = 21) and the time to recovery of the TOF ratio to 70% was 49 min (SD = 19). The mean final twitch height and TOF after recovery from rocuronium blockade were 101% (SD = 15) and 92% (SD = 12), respectively.

Conclusion: The recovery of the responses after neuromuscular blockade to near baseline values shows that acceleromyography can be used to measure neuromuscular block and recovery in neonates and infants.

Keywords

NEUROMUSCULAR BLOCKADE, monitoring, acceleromyographyNEUROMUSCULAR BLOCKING AGENTS, rocuroniumINFANT, NEWBORN
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 1 , January 2005 , pp. 11 - 15
Copyright
© 2005 European Society of Anaesthesiology

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

Viby-Mogensen J. Neuromuscular monitoring. In: Miller ED, ed. Anesthesia, 5th edn. Philadelphia: Churchill Livingstone, 2000: Chapter 36, 1351–1366.
Polhill SL, Clewlow F, Smith DC. Are changes in the evoked electromyogram during anaesthesia without neuromuscular blocking agents caused by failure of supramaximal nerve stimulation? Br J Anaesth 1998; 81: 902–904.Google Scholar
May O, Kirkegaard Nielsen H, Werner MU. The acceleration transducer – an assessment of its precision in comparison with a force displacement transducer. Acta Anaesthesiol Scand 1988; 32: 239–243.Google Scholar
Viby-Mogensen J, Jensen E, Werner M, Kirkegaard Nielsen H. Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand 1988; 32: 45–48.Google Scholar
De Wolff MH, Vanlinthout LEH, van Egmond J, Booij LHDJ. A comparison of mechanomyography and acceleromyography for the assessment of rocuronium induced neuromuscular block. Anesthesiology 2001; 95: A989.Google Scholar
Ansermino JM, Sanderson PM, Bevan JC, Bevan DR. Acceleromyography improves detection of residual neuromuscular blockade in children. Can J Anaesth 1996; 43: 589–594.Google Scholar
Kopman AF, Lawson D. Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology 1984; 61: 83–85.Google Scholar
Girling KJ, Mahajan RP. The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry. Anesth Analg 1996; 82: 1257–1260.Google Scholar
Kopman AF, Kumar S, Klewicka MM, Neuman GG. The staircase phenomenon: implications for monitoring of neuromuscular transmission. Anesthesiology 2001; 95: 403–407.Google Scholar
Brull SJ, Silverman DG. Pulse width, stimulus intensity, electrode placement, and polarity during assessment of neuromuscular block. Anesthesiology 1995; 83: 702–709.Google Scholar
Brull SJ, Ehrenwerth J, Silverman DG. Stimulation with submaximal current for train-of-four monitoring. Anesthesiology 1990; 72: 629–632.Google Scholar
Silverman DG, Connelly NR, O'Connor TZ, Garcia R, Brull SJ. Accelographic train-of-four at near-threshold currents. Anesthesiology 1992; 76: 34–38.Google Scholar
Driessen JJ, Robertson EN, van Egmond J, Booij LHDJ. The time-course of action and recovery of rocuronium 0.3 mg kg−1 in infants and children during halothane anaesthesia measured with acceleromyometry. Paediatr Anaesth 2000; 10: 493–497.Google Scholar
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.Google Scholar
Kopman AF, Klewicka MM, Neuman GG. The relationship between acceleromyographic train-of-four fade and single twitch depression. Anesthesiology 2002; 96: 583–587.Google Scholar