Owusu-Bediako Kwaku, Munch Ryan, Mathias Jay, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Ohio University Heritage College of Osteopathic Medicine - Dublin Campus, Dublin, Ohio, USA.
Saudi J Anaesth. 2022 Oct-Dec;16(4):412-418. doi: 10.4103/sja.sja_326_22. Epub 2022 Sep 3.
Quantitative train-of-four (TOF) monitoring remains essential in optimizing anesthetic outcomes by assessing the depth and recovery from neuromuscular blockade. Despite this, residual neuromuscular blockade, defined as a TOF ratio <0.90, remains a concern in both adult and pediatric patients. Quantitative TOF monitoring has seen limited use in infants and children primarily due to a lack of effective equipment. This study evaluates a new electromyography (EMG)-based TOF monitor in pediatric patients undergoing inpatient surgical procedures including laparoscopic (restricted arm access) surgery.
Pediatric patients undergoing inpatient surgery requiring the administration of neuromuscular blocking agents (NMBAs) were enrolled. The EMG electrodes were placed along the ulnar nerve on the volar aspect of the arm to provide neurostimulation. The muscle action potentials from the abductor digiti minimi muscle were recorded. Neuromuscular responses were recorded by the device throughout surgery at 20-s intervals until after tracheal extubation. Data recorded on the monitor's built-in memory card were later retrieved and analyzed.
The study cohort included 100 pediatric patients (62% male). The average age was 11 years (IQR: 8, 13) and the average weight was 39.6 kg (30, 48.7). Automatic detection of supramaximal stimulus was obtained in 95% of patients. The muscle action potential mean baseline amplitude (in mV) was 7.5 mV (6, 9.2). The baseline TOF ratio was 100% (100, 104). After administration of a neuromuscular blocking agent, monitoring of the TOF ratio was successful in 93% of the patients. After antagonism of neuromuscular blockade, monitoring was possible in 94% of patients when using an upgraded algorithm. The baseline amplitude recovered to 6.5 mV (5, 7.8), and the TOF ratio recovered to a mean of 90.1% (90,97) before tracheal extubation.
Our results indicate that neuromuscular monitoring can be performed intraoperatively in pediatric patients weighing between 20 and 60 kg using the new commercially available EMG-based monitor. Automatic detection of neuromuscular stimulating parameters (supramaximal current intensity level and baseline amplitude of the muscle action potential) by an adult neuromuscular monitor is feasible in pediatric patients receiving nondepolarizing neuromuscular blocking agents.
定量四个成串刺激（TOF）监测对于通过评估神经肌肉阻滞的深度和恢复情况来优化麻醉效果仍然至关重要。尽管如此，残余神经肌肉阻滞（定义为TOF比值<0.90）在成人和儿科患者中仍然是一个问题。定量TOF监测在婴儿和儿童中的应用有限，主要是由于缺乏有效的设备。本研究评估了一种基于肌电图（EMG）的新型TOF监测仪在接受包括腹腔镜（限制手臂通路）手术在内的住院手术的儿科患者中的应用。
纳入接受住院手术且需要使用神经肌肉阻滞剂（NMBAs）的儿科患者。将EMG电极沿手臂掌侧的尺神经放置以提供神经刺激。记录小指展肌的肌肉动作电位。在整个手术过程中，该设备以20秒的间隔记录神经肌肉反应，直至气管拔管后。稍后检索并分析记录在监测仪内置存储卡上的数据。
研究队列包括100名儿科患者（62%为男性）。平均年龄为11岁（四分位间距：8，13），平均体重为39.6千克（30，48.7）。95%的患者实现了超强刺激的自动检测。肌肉动作电位的平均基线幅度（以毫伏计）为7.5毫伏（6，9.2）。基线TOF比值为100%（100，104）。给予神经肌肉阻滞剂后，93%的患者成功监测了TOF比值。在使用升级算法进行神经肌肉阻滞拮抗后，94%的患者能够进行监测。基线幅度恢复到6.5毫伏（5，7.8），TOF比值在气管拔管前恢复到平均90.1%（90，97）。
我们的结果表明，使用新型商用基于EMG的监测仪可在体重20至
60千克的儿科患者术中进行神经肌肉监测。成人神经肌肉监测仪对神经肌肉刺激参数（超强电流强度水平和肌肉动作电位的基线幅度）的自动检测在接受非去极化神经肌肉阻滞剂的儿科患者中是可行的。
