Anesthesiology Department, CHU UCL Namur, Avenue Dr Gaston Thérasse, 1, 5530, Yvoir, Belgium.
Scientific Support Unit, CHU UCL Namur, Avenue Dr Gaston Thérasse, 1, 5530, Yvoir, Belgium.
J Clin Monit Comput. 2020 Feb;34(1):111-116. doi: 10.1007/s10877-019-00287-y. Epub 2019 Feb 26.
The variability or inaccuracy of acceleromyographic measurements could interfere with the interpretation of the train-of-four (TOF) ratio during neuromuscular block (NMB) recovery. This study evaluated the precision and performance of the Philips Intellivue NMT module (NMT) before (part 1) and after (part 2) several technical upgrades (i.e., firmware upgrade, new cable, and hand adapter) that were recently available. Two cohorts of 30 patients who were scheduled to undergo rhino/septoplasty under general anesthesia were included in the study. TOF ratios were recorded simultaneously every 15 s on both hands with the NMT and a TOF-Watch SX installed inside a SL TOF-Tube (TWX). Before rocuronium was administered and once final responses were stabilized, the average of the four successive measurements that determined the baselines and repeatability coefficients were compared using a z test. Simultaneous measurements were recorded at different NMB stages: onset, depth of NMB after intubation, when TWX recovered TOF count 2, TOF ratios 0.5 and 0.9, and when NMT recovered TOF ratio 0.9. The results were compared using a Student t test; p < 0.05 was considered significant. The NMT repeatability coefficients obtained in part 1 were significantly higher than with the TWX, they were significantly lower in part 2. Initially, the NMT significantly overestimated NMB recovery at every stage. Conversely, in the second part of the study, no difference reached statistical significance. With the recent upgrades and the new hand adapter, the NMT provided similar results compared with the TWX, Their implementation should be recommended in clinical practice.
肌动描记测量的可变性或不准确性可能会干扰神经肌肉阻滞 (NMB) 恢复期间四成串（TOF）比值的解释。本研究评估了飞利浦 Intellivue NMT 模块（NMT）在经过几次技术升级（即固件升级、新电缆和手持适配器）前后的精度和性能，这些升级最近已经可用。本研究纳入了两批各 30 名计划在全身麻醉下接受鼻/鼻中隔整形术的患者。使用 NMT 和安装在 SL TOF-Tube（TWX）内的 TOF-Watch SX 每 15 秒同步记录双手的 TOF 比值。在罗库溴铵给药前和最后反应稳定后，使用 z 检验比较用于确定基线和重复性系数的四次连续测量的平均值。在不同的 NMB 阶段记录同步测量：插管后的 NMB 起始、深度，当 TWX 恢复 TOF 计数 2、TOF 比值 0.5 和 0.9 以及 NMT 恢复 TOF 比值 0.9 时。使用学生 t 检验比较结果；p<0.05 被认为具有统计学意义。在第 1 部分中获得的 NMT 重复性系数明显高于 TWX，在第 2 部分中明显降低。最初，NMT 在每个阶段都显著高估了 NMB 的恢复。相反，在研究的第二部分，没有差异达到统计学意义。有了最近的升级和新的手持适配器，NMT 与 TWX 提供了相似的结果，建议在临床实践中采用。
