Department of Anesthesiology, University of Washington, Seattle, Washington.
School of Medicine, University of Washington, Seattle, Washington.
Anesthesiology. 2024 Aug 1;141(2):262-271. doi: 10.1097/ALN.0000000000005051.
The accuracy and precision of currently available, widely used acceleromyograph and electromyograph neuromuscular blockade monitors have not been well studied. In addition, the normalization of the train-of-four ratio from acceleromyography (train-of-four ratio [T4/T1] divided by the baseline train-of-four ratio) has not been validated in comparison to mechanomyography.
Enrolled patients had surgery under general anesthesia with a supraglottic airway and without any neuromuscular blocking drugs. Three acceleromyograph monitors, three electromyograph monitors, and a mechanomyograph built in the authors' laboratory were tested. Most patients had an electromyograph and the mechanomyograph on one arm and a third monitor on the contralateral arm. Train-of-four ratios were collected every 12 to 20 s for the duration of the anesthetic. At least 1,000 train-of-four ratios were recorded for each device. Gauge repeatability and reproducibility analysis was performed.
Twenty-eight patients were enrolled. In total, 9,498 train-of-four ratio measurements were collected. Since no neuromuscular blocking drugs were used, the expected train-of-four ratio was 1.0. All of the acceleromyograph monitors produced overshoot in the train-of-four ratio (estimated means, 1.10 to 1.13) and substantial variability (gauge SDs, 0.07 to 0.18). Normalization of the train-of-four ratio measured by acceleromyography improved the estimated mean for each device (0.97 to 1.0), but the variability was not improved (gauge SDs, 0.06 to 0.17). The electromyograph and the mechanomyograph monitors produced minimal overshoot (estimated means, 0.99 to 1.01) and substantially less variation (gauge SDs, 0.01 to 0.02). For electromyography and mechanomyography, 0.3% of all train-of-four ratios were outside of the range 0.9 to 1.1. For acceleromyography, 27 to 51% of normalized train-of-four ratios were outside the range of 0.9 to 1.1.
Three currently available acceleromyograph monitors produced overshoot and substantial variability that could be clinically significant. Normalization corrected the overshoot in the average results but did not reduce the wide variability. Three electromyograph monitors measured the train-of-four ratio with minimal overshoot and variability, similar to a mechanomyograph.
目前广泛使用的加速度计和肌电图神经肌肉阻滞监测器的准确性和精密度尚未得到很好的研究。此外，加速度计的四肌比（T4/T1 除以基线四肌比）的归一化尚未通过与肌动描记术的比较得到验证。
入组患者在全身麻醉下接受手术，使用声门上气道，不使用任何神经肌肉阻滞剂。测试了三种加速度计监测器、三种肌电图监测器和作者实验室内置的一种肌动描记器。大多数患者的一只手臂上有肌电图和肌动描记器，另一只手臂上有第三台监测器。在麻醉过程中，每 12 到 20 秒采集一次四肌比。为每种设备记录了至少 1000 个四肌比。进行了量具重复性和再现性分析。
共纳入 28 例患者。共采集了 9498 个四肌比测量值。由于未使用神经肌肉阻滞剂，预计四肌比为 1.0。所有加速度计监测器的四肌比均有过冲（估计均值为 1.10 至 1.13），且变异性较大（量具标准差为 0.07 至 0.18）。通过加速度计测量的四肌比的归一化提高了每个设备的估计均值（0.97 至 1.0），但变异性没有改善（量具标准差为 0.06 至 0.17）。肌电图和肌动描记器监测器产生的过冲最小（估计均值为 0.99 至 1.01），且变化明显较小（量具标准差为 0.01 至 0.02）。对于肌电图和肌动描记器，0.3%的四肌比在 0.9 至 1.1 范围之外。对于加速度计，27%至 51%的归一化四肌比在 0.9 至 1.1 范围之外。
三种现有的加速度计监测器产生了较大的过冲和较大的变异性，这可能具有临床意义。归一化纠正了平均结果中的过冲，但并未降低广泛的变异性。三种肌电图监测器测量的四肌比过冲和变异性较小，与肌动描记器相似。
