Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan.
Department of Anesthesia, Indiana University School of Medicine, 1130 W. Michigan St, Fesler Hall 204, Indianapolis, IN, 46202, USA.
BMC Anesthesiol. 2022 Apr 23;22(1):117. doi: 10.1186/s12871-022-01656-y.
The AF-201P, a new electromyography (EMG)-based neuromuscular monitor has been developed recently. The aim of this clinical study was to compare two ulnar nerve innervated muscles: the adductor pollicis (AP) muscle and the abductor digiti minimi (ADM) muscle during the recovery from rocuronium-induced neuromuscular block by using EMG AF-201P.
Twenty patients undergoing surgery with general anesthesia were enrolled in the study. During total intravenous general anesthesia, train-of-four (TOF) and post-tetanic counts (PTC) responses following 0.9 mg/kg rocuronium administration were concurrently monitored at the AP and the ADM muscles with EMG AF-201P on the opposite arms. At the end of the surgery, sugammadex 2 mg/kg was administered when TOF counts of 2 (TOFC2) was observed at both muscles. The primary outcome of the study was time from administration of rocuronium to first appearance of PTC response (first PTC). The secondary outcomes of the study were time from administration of rocuronium to TOF count of 1 (TOFC1), time from first PTC to TOFC1 (PTC-TOF time), time to TOFC2, and time from administration of sugammadex to TOF ratio ≥ 0.9. Agreement between the two muscles was assessed using the Bland-Altman analysis. Data are expressed as mean ± standard deviation.
Nineteen patients were included in the analysis. Time to first PTC was significantly faster at the ADM muscle than the AP muscle (24.4 ± 11.4 min vs 32.4 ± 13.1 min, p = 0.006). PTC-TOF time was significantly longer with the ADM muscle than the AP muscle (19.4 ± 7.3 min vs 12.4 ± 10.6 min, p = 0.019). There were no significant differences in time to TOFC2 and sugammadex-facilitated recovery between the two muscles. Bland-Altman analyses showed acceptable ranges of bias and limits of agreement of the two muscles.
The ADM muscle showed a good agreement with the AP muscle during rocuronium-induced neuromuscular block but faster recovery of PTC response when using EMG.
UMIN-CTR (Registration No. UMIN000044904 ). Registered 19 July 2021 -Retrospectively registered, https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view.cgi?recptno=R000051290 .
最近开发了一种新的基于肌电图（EMG）的神经肌肉监测仪 AF-201P。本临床研究的目的是比较尺神经支配的两块肌肉：拇指内收肌（AP）和小指展肌（ADM），在罗库溴铵诱导的神经肌肉阻滞恢复期间使用 EMG AF-201P。
20 名接受全身麻醉下手术的患者纳入研究。在全身静脉麻醉期间，使用 EMG AF-201P 同时监测 AP 和 ADM 肌肉的四串肌（TOF）和强直后计数（PTC）反应，在给予 0.9mg/kg 罗库溴铵后。在手术结束时，当观察到两块肌肉的 TOF 计数 2（TOFC2）时，给予舒更葡糖 2mg/kg。研究的主要结局是从罗库溴铵给药到首次出现 PTC 反应（首次 PTC）的时间。研究的次要结局是从罗库溴铵给药到 TOF 计数 1（TOFC1）的时间、从首次 PTC 到 TOFC1 的时间（PTC-TOF 时间）、达到 TOFC2 的时间和给予舒更葡糖到 TOF 比值≥0.9 的时间。使用 Bland-Altman 分析评估两块肌肉之间的一致性。数据表示为平均值±标准差。
19 名患者纳入分析。ADM 肌肉的首次 PTC 时间明显快于 AP 肌肉（24.4±11.4min 比 32.4±13.1min，p=0.006）。PTC-TOF 时间 ADM 肌肉明显长于 AP 肌肉（19.4±7.3min 比 12.4±10.6min，p=0.019）。两块肌肉之间达到 TOFC2 和舒更葡糖促进恢复的时间无显著差异。Bland-Altman 分析显示两块肌肉的偏倚和一致性界限在可接受范围内。
在罗库溴铵诱导的神经肌肉阻滞期间，ADM 肌肉与 AP 肌肉具有良好的一致性，但 EMG 恢复更快。
UMIN-CTR（注册号 UMIN000044904）。2021 年 7 月 19 日注册-回顾性注册，https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view.cgi？recptno=R000051290。
