A comparison of a prototype electromyograph vs. a mechanomyograph and an acceleromyograph for assessment of neuromuscular blockade

A Bowdle, L Bussey, K Michaelsen, S Jelacic, B Nair, K Togashi, J Hulvershorn, A Bowdle, L Bussey, K Michaelsen, S Jelacic, B Nair, K Togashi, J Hulvershorn

Abstract

The extent of neuromuscular blockade during anaesthesia is frequently measured using a train-of-four stimulus. Various monitors have been used to quantify the train-of-four, including mechanomyography, acceleromyography and electromyography. Mechanomyography is often considered to be the laboratory gold standard of measurement, but is not commercially available and has rarely been used in clinical practice. Acceleromyography is currently the most commonly used monitor in the clinical setting, whereas electromyography is not widely available. We compared a prototype electromyograph with a newly constructed mechanomyograph and a commercially available acceleromyograph monitor in 43 anesthetised patients. The mean difference (bias; 95% limits of agreement) in train-of-four ratios was 4.7 (-25.2 to 34.6) for mechanomyography vs. electromyography; 14.9 (-13.0 to 42.8) for acceleromyography vs. electromyography; and 9.8 (-31.8 to 51.3) for acceleromyography vs. mechanomyography. The mean difference (95% limits of agreement) in train-of-four ratios between opposite arms when using electromyography was -0.7 (-20.7 to 19.3). There were significantly more acceleromyography train-of-four values > 1.0 (23%) compared with electromyography or mechanomography (2-4%; p < 0.0001). Electromyography most closely resembled mechanomyographic assessment of neuromuscular blockade, whereas acceleromyography frequently produced train-of-four ratio values > 1.0, complicating the interpretation of acceleromyography results in the clinical setting.

Keywords: NMB reversal: acceleromyography assessment; electromyography; mechanomyography; neuromuscular blockade.

© 2019 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

Figures

Figure 1
Figure 1
Mechanomyograph.
Figure 2
Figure 2
Plot of output voltage of mechanomyograph force transducer with added calibration weights.
Figure 3
Figure 3
The electrode array of the electromyograph. Sensing electrodes over the adductor pollicis muscle and first dorsal interosseus muscle; reference electrode on the first finger. The stimulating electrodes were not used.
Figure 4
Figure 4
Simultaneous acceleromyograph, electromyograph and mechanomyograph train‐of‐four values in one patient. Acceleromyograph and electromyograph readings obtained from the same hand, and mechanomyograph readings from the opposite hand. Doses of vecuronium at 0 min (7 mg), 300 min (1 mg), 301 min (1 mg), 467 min (2 mg), 475 min (1 mg). Black – acceleromyograph; dark grey – electromyograph; light grey – mechanomyograph.
Figure 5
Figure 5
Train‐of‐four ratios using mechanomyograph vs. electromyograph. Top: Bland–Altman plot. Shaded area represents 95% limits of agreement. Bottom: scatter plot of individual values.
Figure 6
Figure 6
Train‐of‐four ratios using acceleromyograph (AMG) vs. electromyograph (EMG). Top: Bland–Altman plot. Shaded area represents 95% limits of agreement. Bottom: scatter plot of individual values.
Figure 7
Figure 7
Train‐of‐four ratios using acceleromyograph (AMG) vs. mechanomyograph (MMG). Top: Bland–Altman plot. Shaded area represents 95% limits of agreement. Bottom: scatter plot of individual values.
Figure 8
Figure 8
Train‐of‐four ratios in left arm vs. right arm, using electromyograph. Top: Bland–Altman plot. Shaded area represents 95% limits of agreement. Bottom: scatter plot of individual values.

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Source: PubMed

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