Service d'anesthésie, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
Anaesth Crit Care Pain Med. 2016 Jun;35(3):223-7. doi: 10.1016/j.accpm.2016.01.003. Epub 2016 Feb 16.
Quantitative neuromuscular monitoring is now widely recommended during anesthesia using neuromuscular blocking agents to prevent postoperative residual paralysis and its related complications. We compared the TOF-Watch SX™ accelerometer requiring initial calibration to the TOF-Scan™, a new accelerometer with a preset stimulation intensity of 50mA not necessitating calibration.
This pilot, prospective, observational study included adults undergoing general anesthesia with endotracheal intubation and muscle relaxation, having both arms free during surgery. Accelerometers were set up randomly on each arm. Anesthesia was started with remifentanil and propofol before an intubation dose of atracurium or rocuronium. Train of four stimulation was performed every 15s. Differences between measures were tested using Student's t-test and agreement assessed by Bland and Altman analysis.
Thirty-two patients were included. During onset, a mean bias of -26seconds with a limit of agreement from -172 to +119seconds was observed between TOF-Watch SX™ and TOF-Scan™ to obtain 0 response to TOF. During recovery, TOF-Scan™ showed a significantly later recovery from 1 response to T4/T1>10%, but a bias of 0minute and limits of agreement from -4 to +4minutes for T4/T1>90% (NS).
These results suggest a poor agreement between the calibrated TOF-Watch SX™ and the fix intensity TOF-Scan™ for onset and early recovery of relaxation (i.e. deep neuromuscular blockade) but a good agreement for recovery to TOF 90%. Data are not interchangeable between the devices, but both can be useful to detect residual paralysis.
在使用神经肌肉阻滞剂的麻醉期间，定量神经肌肉监测现在被广泛推荐，以预防术后残余瘫痪及其相关并发症。我们比较了需要初始校准的 TOF-WatchSX™加速度计和新的加速度计 TOF-Scan™，后者的预设刺激强度为 50mA，无需校准。
这项先导性、前瞻性、观察性研究纳入了接受全身麻醉并气管插管和肌肉松弛的成年人，手术期间双臂自由。在每个手臂上随机设置加速度计。麻醉开始时使用瑞芬太尼和丙泊酚，然后给予阿曲库铵或罗库溴铵插管剂量。每隔 15s 进行四次刺激。使用学生 t 检验测试测量值之间的差异，并通过 Bland 和 Altman 分析评估一致性。
共纳入 32 例患者。在起始时，TOF-WatchSX™和 TOF-Scan™获得 TOF 0 反应的平均偏差为-26 秒，一致性界限为-172 至+119 秒。在恢复期间，TOF-Scan™显示从 1 反应到 T4/T1>10%的恢复明显较晚，但 T4/T1>90%的偏差为 0 分钟，一致性界限为-4 至+4 分钟（无统计学意义）。
这些结果表明，校准后的 TOF-WatchSX™和固定强度的 TOF-Scan™之间在松弛（即深度神经肌肉阻滞）的起始和早期恢复方面一致性较差，但在恢复到 TOF 90%方面一致性较好。这两种设备的数据不能互换，但都可以用于检测残余瘫痪。
