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Efficiency of the TOF-Cuff™ for the evaluation of rocuronium-induced neuromuscular block and its reversal with sugammadex: a comparative study vs. acceleromyography

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Abstract

Purpose

The aim of this study was to compare TOF-Cuff™ (TOF-C) and TOF-Watch™ (TOF-W) data following rocuronium-induced neuromuscular block and its reversal with sugammadex.

Methods

Twenty elderly patients aged 68–82 years scheduled for surgery under general anesthesia were enrolled in this study. After induction of anesthesia, neuromuscular block resulting from administration of 0.6 mg/kg rocuronium was concurrently evaluated using TOF-C and TOF-W. The onset of neuromuscular block and duration until the first twitch response following post-tetanic count (PTC) and 2 Hz train-of-four (TOF) stimulation reappeared were evaluated. When the response to the TOF stimulus was detected with both monitors, additional doses of rocuronium were administered to maintain the neuromuscular block. After surgery, 2 mg/kg sugammadex was administered when 1–2 TOF twitches were observed with the TOF-W and the time required for facilitated recovery to a TOF ratio of > 0.9 was assessed.

Results

Regression analyses revealed no statistically significant differences in the mean [SD] onset of rocuronium-induced neuromuscular block [127.8 (27.2) s, 123.5 (30.5) s], time to recovery of the first PTC twitch [23.9 (8.0) min, 25.4 (8.6) min], time to recovery of the first twitch with TOF stimulation [37.2 (8.8) min, 38.9 (11.1) min] and time to adequate reversal with sugammadex [139.2 (30.6) s, 151.8 (31.5) s] between TOF-C and TOF-W, respectively. Bland–Altman analyses also showed acceptable ranges of the biases and limits of agreement between the two methods.

Conclusions

TOF-C may be clinically applicable for the evaluation of both the depth of neuromuscular block and restoration of neuromuscular function.

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References

  1. Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth. 2014;112:498–505.

    Article  CAS  Google Scholar 

  2. Bruintjes MH, van Helden EV, Braat AE, Dahan A, Scheffer GJ, van Laarhoven CJ, Warlé MC. Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis. Br J Anaesth. 2017;118:834–42.

    Article  CAS  Google Scholar 

  3. Carron M. Respiratory benefits of deep neuromuscular block during laparoscopic surgery in a patient with end-stage lung disease. Br J Anaesth. 2015;114:158–9.

    Article  CAS  PubMed  Google Scholar 

  4. Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth Analg. 2013;117:345–51.

    Article  PubMed  Google Scholar 

  5. Hemmerling TM, Le N. Brief review: Neuromuscular monitoring: an update for the clinician. Can J Anaesth. 2007;54:58–72.

    Article  PubMed  Google Scholar 

  6. Kopman AF. Measurement and monitoring of neuromuscular blockade. Curr Opin Anaesthesiol. 2002;15:415–20.

    Article  PubMed  Google Scholar 

  7. Claudius C, Viby-Mogensen J. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence Anesthesiology. 2008;108:1117–40.

    Article  PubMed  Google Scholar 

  8. Suzuki T, Mizutani H, Miyake E, Fukano N, Saeki S, Ogawa S. Infusion requirements and reversibility of rocuronium at the corrugator supercilii and adductor pollicis muscles. Acta Anaesthesiol Scand. 2009;53:1336–40.

    Article  CAS  PubMed  Google Scholar 

  9. Yamamoto S, Yamamoto Y, Kitajima O, Maeda T, Suzuki T. Reversal of neuromuscular block with sugammadex: a comparison of the corrugator supercilii and adductor pollicis muscles in a randomized dose-response study. Acta Anaesthesiol Scand. 2015;59:892–901.

    Article  CAS  PubMed  Google Scholar 

  10. Rodiera J, Serradell A, Álvarez-Gómez JA, Aliaga L. The cuff method: a pilot study of a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand. 2005;49:1552–8.

    Article  CAS  PubMed  Google Scholar 

  11. Yoshida F, Suzuki T, Kashiwai A, Furuya T, Konishi J, Ogawa S. Correlation between cardiac output and reversibility of rocuronium-induced moderate neuromuscular block with sugammadex. Acta Anaesthesiol Scand. 2012;56:83–7.

    Article  CAS  PubMed  Google Scholar 

  12. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  CAS  PubMed  Google Scholar 

  13. Johnson MA, Polgar J, Weightman D, Appleton D. Data on the distribution of fibre types in thirty-six human muscles. An autopsy study. J Neurol Sci. 1973;18:111–29.

    Article  CAS  Google Scholar 

  14. Sterz R, Pagala M, Peper K. Postjunctional characteristics of the endplates in mammalian fast and slow muscles. Pflügers Arch. 1983;398:48–54.

    Article  CAS  PubMed  Google Scholar 

  15. Ibebunjo C, Srikant CB, Donati F. Morphological correlates of the differential responses of muscles to vecuronium. Br J Anaesth. 1999;83:284–91.

    Article  CAS  PubMed  Google Scholar 

  16. Suzuki T, Fukano N, Kitajima O, Saeki S, Ogawa S. Normalization of acceleromyographic train-of-four ratio by baseline value for detecting residual neuromuscular block. Br J Anaesth. 2006;96:44–7.

    Article  CAS  PubMed  Google Scholar 

  17. Kopman AF, Kopman DJ. An analysis of the TOF-watch algorithm for modifying the displayed train-of-four ratio. Acta Anaesthesiol Scand. 2006;50:1313–4.

    Article  CAS  PubMed  Google Scholar 

  18. Arain SR, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49:312–5.

    Article  CAS  PubMed  Google Scholar 

  19. Furuya T, Suzuki T, Kashiwai A, Konishi J, Aono M, Hirose N, Kato J, Ogawa S. The effects of age on maintenance of intense neuromuscular block with rocuronium. Acta Anaesthesiol Scand. 2012;56:236–9.

    Article  CAS  PubMed  Google Scholar 

  20. Suzuki T, Kitajima O, Ueda K, Kondo Y, Kato J, Ogawa S. Reversibility of rocuronium-induced profound neuromuscular block with sugammadex in younger and older patients. Br J Anaesth. 2011;106:823–6.

    Article  CAS  PubMed  Google Scholar 

  21. Shiraishi N, Aono M, Kameyama Y, Yamamoto M, Kitajima O, Suzuki T. Effects of cardiac output on the onset of rocuronium-induced neuromuscular block in elderly patients. J Anesth. 2018;32:547–50.

    Article  PubMed  Google Scholar 

  22. Kopman A, Lawson D. Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology. 1984;61:83–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Financial support: departmental funding.

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Author notes

  1. Yasuhito Kameyama and Shunichi Takagi are equally contributing first authors of this article.

Authors and Affiliations

  1. Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi Kami-Cho, Itabashi-Ku, 173-8610, Tokyo, Japan

    Yasuhito Kameyama, Shunichi Takagi, Katsuhisa Seto, Ichie Kajiwara, Miori Goto, Osamu Kitajima & Takahiro Suzuki

Authors
  1. Yasuhito Kameyama
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  2. Shunichi Takagi
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  3. Katsuhisa Seto
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  4. Ichie Kajiwara
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  5. Miori Goto
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  6. Osamu Kitajima
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  7. Takahiro Suzuki
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Corresponding author

Correspondence to Takahiro Suzuki.

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Conflict of interest

Shunichi Takagi and Takahiro Suzuki have received speaker fees from MSD Inc., Japan.

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Kameyama, Y., Takagi, S., Seto, K. et al. Efficiency of the TOF-Cuff™ for the evaluation of rocuronium-induced neuromuscular block and its reversal with sugammadex: a comparative study vs. acceleromyography. J Anesth 33, 80–84 (2019). https://doi.org/10.1007/s00540-018-2587-4

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  • DOI: https://doi.org/10.1007/s00540-018-2587-4

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