Department of Health Sciences, University of Milan, Milan, Italy.
Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
J Clin Anesth. 2021 Dec;75:110481. doi: 10.1016/j.jclinane.2021.110481. Epub 2021 Aug 10.
Neuromuscular monitoring has become a standard of care for management of anesthesia. While acceleromyography (AMG) is the most common technology used in clinical practice, guidelines suggest that electromyographic (EMG) devices are ideal for quantitative neuromuscular monitoring. The Tetragraph® is an EMG monitor that has recently been marketed.
The aim of this study is to assess the agreement during recovery from neuromuscular blockade of this new monitor with the TOF Watch® SX, and to compare intraobserver variability for the two devices.
Single-center, prospective, observational clinical study.
Operating room.
Twenty-three patients were enrolled and twenty patients were included in the analysis.
A comparison of TOF-ratios measured sequentially from the same hand with the Tetragraph and TOF Watch SX was conducted during spontaneous recovery of neuromuscular function from patients that received rocuronium during surgery.
We used Bland-Altman plots for repeated measures to compare TOF-ratios obtained sequentially by the two devices. Subsequent measures with the same device were used to calculate intraobserver variability for each monitor.
The bias between AMG and EMG for TOF-ratios range between 0.2 and 1.0 was 0.13 (95% CI 0.08 to 0.18) and the limits of agreement (LoA) were - 0.11 (95% CI -0.20 to -0.06) and 0.37 (95% CI 0.32 to 0.46), respectively. Agreement slightly improved for TOF-ratios higher than 0.8 compared with lower TOF-ratios: the bias was 0.12 (95% CI 0.08 to 0.17) and 0.13 (95% CI 0.08 to 0.19), respectively. EMG relative intraobserver variability was lower compared with AMG (2.0%, IQR 0.0% to 4.5% vs. 3.2%, IQR 1.2% to 6.0%, P = 0.001).
Bias between the TOF Watch SX and the Tetragraph TOF-ratios is in line with previous results for AMG and EMG monitors.
神经肌肉监测已成为麻醉管理的标准。尽管加速肌电图（AMG）是临床实践中最常用的技术，但指南建议肌电图（EMG）设备是定量神经肌肉监测的理想选择。Tetragraph®是一种最近上市的 EMG 监测器。
本研究旨在评估该新型监测仪与 TOF Watch®SX 在神经肌肉阻滞恢复期间的一致性，并比较两种设备的观察者内变异性。
单中心、前瞻性、观察性临床研究。
手术室。
纳入 23 名患者，20 名患者纳入分析。
在手术中接受罗库溴铵的患者中，在神经肌肉功能自发恢复期间，比较从同一只手顺序测量的 TOF 比值与 Tetragraph 和 TOF Watch SX 之间的关系。
我们使用重复测量的 Bland-Altman 图来比较两种设备顺序获得的 TOF 比值。使用相同设备的后续测量来计算每个监测器的观察者内变异性。
AMG 和 EMG 之间的 TOF 比值偏差范围在 0.2 到 1.0 之间，为 0.13（95%CI 0.08 到 0.18），其一致性界限（LoA）分别为-0.11（95%CI -0.20 到 -0.06）和 0.37（95%CI 0.32 到 0.46）。与较低的 TOF 比值相比，TOF 比值较高时，偏差略有改善：偏差分别为 0.12（95%CI 0.08 到 0.17）和 0.13（95%CI 0.08 到 0.19）。与 AMG 相比，EMG 的相对观察者内变异性较低（2.0%，IQR 0.0%到 4.5%比 3.2%，IQR 1.2%到 6.0%，P=0.001）。
TOF Watch SX 与 Tetragraph TOF 比值之间的偏差与 AMG 和 EMG 监测器的先前结果一致。
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