Bansal A, Stewart P A, Phillips S, Liang S, Wang X
Consultant Anaesthetist, Sydney Adventist Hospital; Clinical Senior Lecturer, University of Sydney; Sydney, New South Wales.
Specialist Anaesthetist, Department of Anaesthesia, Sydney Adventist Hospital; Associate Professor, Sydney Adventist Clinical School, University of Sydney; Sydney, New South Wales.
Anaesth Intensive Care. 2018 Nov;46(6):614-619. doi: 10.1177/0310057X1804600613.
Accurate and reliable quantitative neuromuscular function monitoring is desirable for the optimal management of neuromuscular blockade, selection of the most appropriate reversal agent and dosage, and assessing the completeness of reversal to exclude residual neuromuscular blockade. Applying preload to the thumb may affect the precision of electromyography. This study compared the precision and agreement of electromyography with and without preload during recovery from non-depolarising neuromuscular blockade. After induction of anaesthesia and before neuromuscular blockade, the supramaximal current required at the first dorsal interosseous muscle with and without preload was determined. During recovery, train-of-four ratios were recorded using electromyography every 20 seconds. Alternating pairs of measurements (with and without preload) were obtained until spontaneous recovery was achieved. The preload device applied a resting tension of 75-150 g to the thumb. Bland-Altman analysis for repeated measurements was used to assess precision and agreement of electromyography responses with and without muscle preload. Two hundred and seventy-five sets of repeated measurements were collected from 35 participants. The repeatability coefficient for train-of-four ratios recorded by electromyography with a preload was 0.030 (95% confidence intervals, CI, 0.028 to 0.031) versus 0.068 (95% CI 0.064 to 0.072) without. Train-of-four ratios with preload demonstrated a bias of +0.038 (95% CI 0.037 to 0.042) compared to electromyography without, with 95% limits of agreement of 0.035-0.111. Preload significantly improved the precision of electromyographic train-of-four ratios, with 95% of consecutive measurements differing by less than 3%. Furthermore, electromyography with preload demonstrated a positive bias of 0.04 compared with electromyography alone, the clinical significance of which requires further research.
准确可靠的定量神经肌肉功能监测对于神经肌肉阻滞的优化管理、选择最合适的逆转剂和剂量以及评估逆转的完整性以排除残余神经肌肉阻滞是很有必要的。对拇指施加预负荷可能会影响肌电图的精度。本研究比较了非去极化神经肌肉阻滞恢复期间有预负荷和无预负荷时肌电图的精度和一致性。在麻醉诱导后和神经肌肉阻滞前，测定了第一背侧骨间肌在有预负荷和无预负荷时所需的超强电流。在恢复过程中，每20秒使用肌电图记录四个成串刺激比值。交替进行有预负荷和无预负荷的成对测量，直到实现自发恢复。预负荷装置对拇指施加75-150克的静息张力。采用重复测量的Bland-Altman分析来评估有肌肉预负荷和无肌肉预负荷时肌电图反应的精度和一致性。从35名参与者中收集了275组重复测量数据。有预负荷时肌电图记录的四个成串刺激比值的重复性系数为0.030（95%置信区间，CI，0.028至0.031），无预负荷时为0.068（95%CI 0.064至0.072）。与无预负荷的肌电图相比，有预负荷的四个成串刺激比值显示出+0.038（95%CI 0.037至0.042）的偏差，95%的一致性界限为0.035-0.111。预负荷显著提高了肌电图四个成串刺激比值的精度，95%的连续测量差异小于3%。此外，有预负荷的肌电图与单独的肌电图相比显示出0.04的正偏差，其临床意义需要进一步研究。
