Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.
J Anesth. 2024 Dec;38(6):811-820. doi: 10.1007/s00540-024-03397-3. Epub 2024 Aug 31.
We evaluated the electromyography (EMG)-based neuromuscular monitoring detectability of our novel stimulating electrode attachment method compared to the original Nihon-Kohden (Tokyo, Japan) attachment method.
This single-center randomized, double-blind, controlled pilot study enrolled 32 patients aged ≥ 18 years, undergoing scheduled laparoscopic surgery. The EMG electrode NM-345Y™ was attached to one forearm using the Nihon-Kohden method (Pattern N-K) and the other forearm using our novel method (Pattern Cross). The allocation to each attachment method was determined post-randomization. In Pattern Cross, the NM-345Y™ was attached such that the line connecting the anode and cathode crosses the ulnar nerve. Patients received 0.9 mg/kg rocuronium after calibration with the forearm in 90-degree supination. Following tracheal intubation, the forearm was positioned in 0-degree pronation. Intraoperatively, 0.2 mg/kg rocuronium was administered if the train-of-four (TOF) count one persisted for 1 min on either side. Post-surgery, the forearm position was returned to 90-degree supination, and rocuronium was antagonized with sugammadex. TOF and post-tetanic count (PTC) were simultaneously measured bilaterally every 15 s and 5 min, respectively, from post-calibration to tracheal extubation.
The time to first PTC appearance was significantly shorter by 33 min in the Pattern Cross group than in the Pattern N-K group (95% Confidence interval: 1-66, p = 0.043). Following sugammadex administration, TOF ratios ≥ 0.9 were achieved in 72% of patients in the Pattern N-K group and 97% of those in the Pattern Cross group (p = 0.025).
Crossing the line connecting the anode and cathode with the ulnar nerve stabilizes EMG-based neuromuscular monitoring detectability.
我们评估了新型刺激电极附接方法与原始尼森-高登（日本东京）附接方法相比，基于肌电图（EMG）的神经肌肉监测的可检测性。
这是一项单中心随机、双盲、对照的初步研究，纳入了 32 名年龄≥18 岁、接受择期腹腔镜手术的患者。将 NM-345Y™ EMG 电极使用尼森-高登法（Pattern N-K）附接于一侧前臂，使用我们的新型方法（Pattern Cross）附接于另一侧前臂。在随机分组后确定每个附接方法的分配。在 Pattern Cross 中，将 NM-345Y™ 附接，使得连接阳极和阴极的线穿过尺神经。在 90 度旋后位校准前臂后，患者接受 0.9mg/kg 罗库溴铵。气管插管后，将前臂置于 0 度旋前位。术中，如果任一侧的肌颤搐计数（TOF）计数 1 持续 1 分钟，就给予 0.2mg/kg 罗库溴铵。术后，将前臂位置恢复到 90 度旋后位，并用琥珀酸舒更葡糖拮抗罗库溴铵。从校准后到气管拔管，双侧每隔 15 秒同时测量 TOF 和强直后计数（PTC），分别持续 5 分钟。
Pattern Cross 组的首次 PTC 出现时间明显比 Pattern N-K 组短 33 分钟（95%置信区间：1-66，p=0.043）。给予琥珀酸舒更葡糖后，Pattern N-K 组 72%的患者和 Pattern Cross 组 97%的患者 TOF 比值≥0.9（p=0.025）。
与尺神经交叉连接阳极和阴极的线可稳定基于肌电图的神经肌肉监测的可检测性。
