Grabarczyk Łukasz
Alarm Clock Clinic, Coma Recovery and Neurorehabilitation Center, Warsaw, Poland.
Med Sci Monit. 2025 Jul 20;31:e948980. doi: 10.12659/MSM.948980.
Residual neuromuscular blockade occurs in 20-40% of patients following the use of neuromuscular blocking agents (NMBAs) during general anesthesia, with the potential for serious complications. Despite the publication of formal guidelines, routine objective neuromuscular monitoring remains underused in many clinical settings, often due to misconceptions about its necessity, time constraints, and lack of equipment. However, clinical signs alone, such as the ability to perform basic motor tasks, are unreliable, especially in vulnerable populations. Objective methods like acceleromyography (AMG), mechanomyography (MMG), and electromyography (EMG) provide accurate measurements but may still face challenges like artifacts and technological limitations. In 2024, several significant advances were made in this field, including new reviews on the use of neuromuscular blockade in special clinical situations, comparisons of train-of-four (TOF) Scan and TOF-Cuff in different locations, and the development of new device prototypes. Briefly, in clinical practice, the predominant method is acceleromyography, although it is associated with high variability and systematic measurement error. Compressomyography, which also enables simultaneous blood pressure measurement, is of secondary importance. Kinemyography, sonomyography, and sonomechanomyography are rarely used alternatives to the more commonly employed techniques. Despite the abundance of methods and devices, the use of neuromonitoring in clinical practice worldwide remains low. Studies indicate that clinician education alone does not increase the frequency of neuromonitoring in clinical settings. However, a multifaceted intervention - including equipment trials, educational videos, quantitative monitors in all anesthetizing locations, electronic clinical decision support with real-time alerts, and ongoing professional practice metrics - has proven to be effective.
全身麻醉期间使用神经肌肉阻滞剂（NMBAs）后，20%-40%的患者会出现残余神经肌肉阻滞，存在发生严重并发症的风险。尽管已发布了正式指南，但在许多临床环境中，常规的客观神经肌肉监测仍未得到充分利用，这通常是由于对其必要性存在误解、时间限制以及设备短缺。然而，仅凭临床体征，如执行基本运动任务的能力，是不可靠的，尤其是在脆弱人群中。诸如加速度肌电图（AMG）、机械肌电图（MMG）和肌电图（EMG）等客观方法可提供准确测量结果，但仍可能面临诸如伪迹和技术限制等挑战。2024年，该领域取得了多项重大进展，包括对特殊临床情况下神经肌肉阻滞使用的新综述、不同部位四个成串刺激（TOF）扫描与TOF袖带的比较，以及新设备原型的开发。简而言之，在临床实践中，主要方法是加速度肌电图，尽管它存在高变异性和系统测量误差。还能同时测量血压的压迫肌电图则次之。运动肌电图、超声肌电图和超声机械肌电图是较少使用的替代方法，相比之下，更常用的技术更为普遍。尽管有大量的方法和设备，但全球范围内神经监测在临床实践中的应用率仍然很低。研究表明，仅靠临床医生教育并不能提高临床环境中神经监测的频率。然而，多方面的干预措施——包括设备试验、教育视频、所有麻醉地点的定量监测仪、具有实时警报功能的电子临床决策支持以及持续的专业实践指标——已被证明是有效的。
