Epstein Richard H, Nemes Réka, Renew Johnathan R, Brull Sorin J
Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA.
Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary.
BJA Open. 2024 Jun 13;11:100293. doi: 10.1016/j.bjao.2024.100293. eCollection 2024 Sep.
Current guidelines recommend quantitative neuromuscular block monitoring during neuromuscular blocking agent administration. Monitors using surface electromyography (EMG) determine compound motor action potential (cMAP) amplitude or area under the curve (AUC). Rigorous evaluation of the interchangeability of these methods is lacking but necessary for clinical and research assurance that EMG interpretations of the depth of neuromuscular block are not affected by the methodology.
Digitised EMG waveforms were studied from 48 patients given rocuronium during two published studies. The EMG amplitudes and AUCs were calculated pairwise from all cMAPs classified as valid by visual inspection. Ratios of the first twitch (T) to the control T before administration of rocuronium (Tc) and train-of-four ratios (TOFRs) were compared using repeated measures Bland-Altman analysis.
Among the 2419 paired T/Tc differences where the average T/Tc was ≤0.2, eight (0.33%) were outside prespecified clinical limits of agreement (-0.148 to 0.164). Among the 1781 paired TOFR differences where the average TOFR was ≥0.8, 70 (3.93%) were outside the prespecified clinical limits of agreement ((-0.109 to 0.134). Among all 7286 T/Tc paired differences, the mean bias was 0.32 (95% confidence interval 0.202-0.043), and among all 5559 paired TOFR differences, the mean bias was 0.011 (95% confidence interval 0.0050-0.017). Among paired T/Tc and TOFR differences, Lin's concordance correlation coefficients were 0.98 and 0.995, respectively. Repeatability coefficients for T/Tc and TOFR were <0.08, with no differences between methods.
Quantitative assessment neuromuscular block depth is clinically interchangeable when calculated using cMAP amplitude or the AUC.
当前指南建议在使用神经肌肉阻滞剂期间进行定量神经肌肉阻滞监测。使用表面肌电图（EMG）的监测仪可测定复合运动动作电位（cMAP）的幅度或曲线下面积（AUC）。目前缺乏对这些方法互换性的严格评估，但对于临床和研究而言，确保神经肌肉阻滞深度的EMG解释不受方法学影响是必要的。
在两项已发表的研究中，对48例接受罗库溴铵治疗的患者的数字化EMG波形进行了研究。通过目视检查将所有cMAP分类为有效后，两两计算EMG幅度和AUC。使用重复测量的Bland-Altman分析比较首次肌颤搐（T）与罗库溴铵给药前对照肌颤搐（Tc）的比值以及四个成串刺激比值（TOFR）。
在平均T/Tc≤0.2的2419对T/Tc差值中，有8对（0.33%）超出了预先设定的临床一致性界限（-0.148至0.164）。在平均TOFR≥0.8的1781对TOFR差值中，有70对（3.93%）超出了预先设定的临床一致性界限（-0.109至0.134）。在所有7286对T/Tc差值中，平均偏差为0.32（95%置信区间0.202 - 0.043），在所有5559对TOFR差值中，平均偏差为0.011（95%置信区间0.0050 - 0.017）。在成对的T/Tc和TOFR差值中，林氏一致性相关系数分别为0.98和0.995。T/Tc和TOFR的重复性系数<0.08，两种方法之间无差异。
使用cMAP幅度或AUC计算时，神经肌肉阻滞深度的定量评估在临床上具有互换性。
