在改良快速序列诱导期间进行神经肌肉监测：TOF-Cuff® 和 TOF-Scan® 的比较。

Neuromuscular monitoring during modified rapid sequence induction: A comparison of TOF-Cuff® and TOF-Scan®.

机构信息

Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau Frauenfeld, Frauenfeld, Switzerland.

出版信息

Australas Emerg Care. 2020 Dec;23(4):217-220. doi: 10.1016/j.auec.2020.02.005. Epub 2020 Mar 12.

DOI:10.1016/j.auec.2020.02.005

PMID:32173276

Abstract

BACKGROUND

Acceleromyometry is the clinical standard for quantitative neuromuscular monitoring, mostly using the stimulation pattern train-of-four (TOF). TOF-Cuff®, a recently introduced neuromuscular monitor with stimulating electrodes integrated within a blood pressure cuff, assesses the muscular response in the upper arm.

METHODS

The time from administration of a neuromuscular blocking agent to TOF-ratio 0% during modified rapid sequence induction was compared between TOF-Cuff® and acceleromyometry (TOF-Scan®). Included were 26 adults with body mass index <35 kg/m. TOF-Scan® and TOF-Cuff® were simultaneously fitted on patients' opposite arms. The mean difference to TOF-ratio 0% was compared using the one sample t-test (p < 0.05) and Bland-Altman plots.

RESULTS

After anesthesia induction, atracurium 0.9 mg/kg (±0.08) i.v. was administered. The mean time to TOF ratio 0% for TOF-Scan® was 140.4 s (±34.3), and 132.7 s (±32.5) for TOF-Cuff®, with a mean difference of 5.4 (95% CI: -9.9 to 20.7, p = 0.472). The maximum difference between the two modalities was 135 s when the TOF-Cuff® was faster and 60 s when the TOF-Scan® was faster.

CONCLUSIONS

No statistically significant systematic difference was found between TOF-Scan® and TOF-Cuff®. However, there was high variability and wide limits of agreement. The two devices cannot be used interchangeably.

摘要

背景

加速肌电图是定量神经肌肉监测的临床标准，主要使用刺激模式四脉冲串（TOF）。TOF-Cuff®是一种最近引入的神经肌肉监测器，其刺激电极集成在血压袖带内，评估上臂的肌肉反应。

方法

在改良快速序列诱导过程中，从给予神经肌肉阻滞剂到 TOF 比 0%的时间，TOF-Cuff®和加速肌电图（TOF-Scan®）之间进行了比较。纳入 26 名 BMI<35 kg/m 的成年人。TOF-Scan®和 TOF-Cuff®同时安装在患者的对侧手臂上。使用单样本 t 检验（p<0.05）和 Bland-Altman 图比较 TOF 比值 0%的平均差值。

结果

麻醉诱导后，静脉注射 0.9 mg/kg（±0.08）阿曲库铵。TOF-Scan®的 TOF 比值 0%的平均时间为 140.4 s（±34.3），TOF-Cuff®为 132.7 s（±32.5），平均差异为 5.4（95%CI：-9.9 至 20.7，p=0.472）。两种方式之间的最大差异为 135 s，当 TOF-Cuff®更快时，为 60 s，当 TOF-Scan®更快时。