Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA; Crown Veterinary Specialists, Lebanon, NJ, USA.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA; Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
Vet Anaesth Analg. 2023 Sep;50(5):408-414. doi: 10.1016/j.vaa.2023.06.002. Epub 2023 Jun 13.
To compare the ratio of the train-of-four (TOF) and double burst stimulation (DBS) obtained with three-axial acceleromyography (AMG) and mechanomyography (MMG) in dogs during recovery from a rocuronium-induced neuromuscular block.
Prospective, randomized, experimental study.
A total of six intact healthy adult male Beagle dogs, weighing 9.1 ± 1.9 kg and aged 3-5 years.
Dogs were anesthetized with intravenous (IV) dexmedetomidine and propofol, and isoflurane in oxygen. Neuromuscular function was measured with AMG and MMG in the contralateral thoracic limbs. Rocuronium (0.5 mg kg) was administered IV, and the TOF and DBS ratios measured. During neuromuscular block offset, MMG values were recorded when AMG first reached ratios of 0.9 and 1.0. True recovery from neuromuscular block was determined as MMG ratio ≥ 0.9. The false-positive (AMG ≥ 0.9 or 1.0, and MMG ratio < 0.9) rate was determined. Paired values were compared, and bias and limits of agreement were calculated. Receiver operating characteristic (ROC) curves were created.
When AMG first reached 0.9 and 1.0 during recovery, MMG values were lower (p < 0.040). When AMG reached 0.9, the false-positive rate was 29% with TOF and 27% with DBS. It decreased to 12% (TOF) and 11% (DBS) when a ratio of 1.0 was used. AMG values were higher than paired MMG values (p < 0.001). The AMG overestimated MMG by 24% and 22% for TOF and DBS, respectively. Areas under the ROC curves (95% confidence interval) were 0.91 (0.89, 0.94) and 0.86 (0.81, 0.94) for TOF and DBS, respectively.
and clinical relevance The three-axial AMG monitor overestimated neuromuscular function and, in some cases, indicated adequate recovery despite the MMG ratio being < 0.9. A TOF or DBS ratio of at least 1.0 should be considered when monitoring recovery of neuromuscular block with this AMG device.
比较使用三轴加速肌描记法（AMG）和机械肌描记法（MMG）在犬恢复罗库溴铵诱导的神经肌肉阻滞时获得的四个成串刺激（TOF）和双爆发刺激（DBS）的比值。
前瞻性、随机、实验研究。
共 6 只完整健康的成年雄性比格犬，体重 9.1±1.9kg，年龄 3-5 岁。
犬静脉（IV）给予右美托咪定和丙泊酚及氧气中的异氟烷麻醉。使用 AMG 和 MMG 在对侧胸肢测量神经肌肉功能。静脉给予罗库溴铵（0.5mg/kg），测量 TOF 和 DBS 比值。在神经肌肉阻滞消退期间，当 AMG 首次达到 0.9 和 1.0 比值时，记录 MMG 值。确定神经肌肉阻滞的真正恢复为 MMG 比值≥0.9。确定假阳性（AMG≥0.9 或 1.0，且 MMG 比值<0.9）率。比较配对值，并计算偏差和一致性界限。创建接收器操作特性（ROC）曲线。
在恢复过程中，当 AMG 首次达到 0.9 和 1.0 时，MMG 值较低（p<0.040）。当 AMG 达到 0.9 时，TOF 和 DBS 的假阳性率分别为 29%和 27%。当使用比值 1.0 时，假阳性率分别降至 12%（TOF）和 11%（DBS）。AMG 值高于配对 MMG 值（p<0.001）。AMG 分别高估了 TOF 和 DBS 的 MMG 24%和 22%。TOF 和 DBS 的 ROC 曲线下面积（95%置信区间）分别为 0.91（0.89，0.94）和 0.86（0.81，0.94）。
与临床相关性 三轴 AMG 监测器高估了神经肌肉功能，并且在某些情况下，尽管 MMG 比值<0.9，仍表明恢复充分。在使用该 AMG 设备监测神经肌肉阻滞恢复时，应考虑 TOF 或 DBS 比值至少为 1.0。
