Kaneko Shohei, Makino Madoka, Miyagawa Kana, Murata Hiroaki, Hara Tetsuya
Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN.
Cureus. 2024 Feb 11;16(2):e54024. doi: 10.7759/cureus.54024. eCollection 2024 Feb.
Neuromuscular monitoring is crucial during the administration of neuromuscular blocking agents owing to individual variations in their effects. In electromyography (EMG)-based neuromuscular monitoring using the EMG electrodes (NM-345Y™, Nihon-Kohden Corporation, Tokyo, Japan) following the manufacturer-recommended attachment method, the accuracy of neuromuscular monitoring may be reduced when forearm limb position is changed. We previously devised a novel attachment method for NM-345Y™ stimulating electrodes in adult volunteers to maintain stable monitoring accuracy despite changes in forearm position. Its effectiveness in clinical practice was evaluated by conducting a descriptive study on a 52-year-old woman undergoing laparoscopic uterine surgery. NM-345Y™ electrodes were attached to each forearm following the manufacturer's recommendations (Pattern N) and our novel method (Pattern C). In Pattern C, NM-345Y™ was attached without ultrasound guidance so that the ulnar nerve crossed the line connecting the centers of the anode and cathode of the stimulating electrode. Pattern C exhibited consistent EMG-based monitoring accuracy even with changes in forearm position despite a smaller stimulus current value at calibration. Additionally, Pattern C displayed reliable recovery of the train-of-four (TOF) response after sugammadex administration in the original forearm position, with no observed adverse events. In contrast, Pattern N showed unstable monitoring accuracy after forearm position changes, highlighting the danger of imprecise EMG-based neuromuscular monitoring during the administration of neuromuscular blocking agents. The study's strength lies in identifying Pattern C, where the ulnar nerve crosses the line connecting the anode and cathode, significantly enhancing monitoring accuracy. This novel attachment method holds promise to improve EMG-based neuromuscular monitoring precision in surgery involving forearm limb position changes, although further research is required to assess its utility comprehensively.
由于神经肌肉阻滞剂的个体效应差异,在其给药过程中神经肌肉监测至关重要。在基于肌电图(EMG)的神经肌肉监测中,使用肌电图电极(NM - 345Y™,日本光电株式会社,东京,日本)并遵循制造商推荐的附着方法时,前臂肢体位置改变可能会降低神经肌肉监测的准确性。我们之前为成年志愿者设计了一种NM - 345Y™刺激电极的新型附着方法,以在前臂位置改变时仍保持稳定的监测准确性。通过对一名接受腹腔镜子宫手术的52岁女性进行描述性研究,评估了其在临床实践中的有效性。按照制造商的建议(模式N)和我们的新方法(模式C)将NM - 345Y™电极附着于每个前臂。在模式C中,NM - 345Y™在没有超声引导的情况下附着,使尺神经穿过刺激电极阳极和阴极中心连线。即使前臂位置改变,模式C在基于EMG的监测中仍表现出一致的准确性,尽管在校准时刺激电流值较小。此外,在原始前臂位置给予舒更葡糖后,模式C显示出可靠的四个成串刺激(TOF)反应恢复,且未观察到不良事件。相比之下,模式N在前臂位置改变后监测准确性不稳定,突出了在神经肌肉阻滞剂给药期间基于EMG的神经肌肉监测不准确的危险性。该研究的优势在于确定了模式C,即尺神经穿过阳极和阴极连线的位置,显著提高了监测准确性。这种新型附着方法有望提高涉及前臂肢体位置改变的手术中基于EMG的神经肌肉监测精度,尽管需要进一步研究以全面评估其效用。