Counting train-of-four twitch response: comparison of palpation to mechanomyography, acceleromyography, and electromyography
Andrew Bowdle, Logan Bussey, Kelly Michaelsen, Srdjan Jelacic, Bala Nair, Kei Togashi, Justin Hulvershorn, Andrew Bowdle, Logan Bussey, Kelly Michaelsen, Srdjan Jelacic, Bala Nair, Kei Togashi, Justin Hulvershorn
Abstract
Background: Train-of-four twitch monitoring can be performed using palpation of thumb movement, or by the use of a more objective quantitative monitor, such as mechanomyography, acceleromyography, or electromyography. The relative performance of palpation and quantitative monitoring for determination of the train-of-four ratio has been studied extensively, but the relative performance of palpation and quantitative monitors for counting train-of-four twitch responses has not been completely described.
Methods: We compared train-of-four counts by palpation to mechanomyography, acceleromyography (Stimpod™), and electromyography (TwitchView Monitor™) in anaesthetised patients using 1691 pairs of measurements obtained from 46 subjects.
Results: There was substantial agreement between palpation and electromyography (kappa = 0.80), mechanomyography (kappa = 0.67), or acceleromyography (kappa = 0.63). Electromyography with TwitchView and mechanomyography most closely resembled palpation, whereas acceleromyography with StimPod often underestimated train-of-four count. With palpation as the comparator, acceleromyography was more likely to measure a lower train-of-four count, with 36% of counts less than palpation, and 3% more than palpation. For mechanomyography, 31% of train-of-four counts were greater than palpation, and 9% were less. For electromyography, 15% of train-of-four counts were greater than palpation, and 12% were less. The agreement between acceleromyography and electromyography was fair (kappa = 0.38). For acceleromyography, 39% of train-of-four counts were less than electromyography, and 5% were more.
Conclusions: Acceleromyography with the StimPod frequently underestimated train-of-four count in comparison with electromyography with TwitchView.
Keywords: acceleromyography; electromyography; mechanomyography; monitor; neuromuscular blocking agent; reversal.
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
Source: PubMed