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Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young adults (STSTS-Study): a prospective randomised, controlled trial

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Abstract

Acceleromyography is characterised by an increase of the twitch response T1 (first twitch of the train-of-four [TOF]) during first 30 min of monitoring known as the staircase phenomenon. In adults the staircase phenomenon can be avoided by tetanic prestimulation. This study examined, if tetanic prestimulation eliminates the staircase phenomenon in children. After written informed consent, the neuromuscular function of 80 children, 10 in each age group (< 6 months, 6–12 months, 12–24 months, 2–3 years, 3–6 years, 6–12 years, 12–18 years, and ≥ 18 years) was measured on both arms simultaneously over 30 min under general anaesthesia. The ulnaris nerve was stimulated using the TOF technique every 15 s. The twitch response (T1, TOF ratio [TOFR]) was measured by acceleromyography. Before calibration, tetanic prestimmulation (50 Hz for 5 s) was administered to one randomly selected arm. The effect of tetanic prestimulation and age was analysed using general linear models based on the normalized T1 and TOFRs of both arms. Tetanic prestimulation significantly affected T1 values avoiding the staircase phenomenon (p < 0.0001). After 5.8 min [1.0–17.2 min] the normalized T1 values increased to 117% [102–147%] without prestimulation (p < 0.0001) independent of the age group (p = 0.539). The normalized TOFR was stable throughout the observation period of 30 min 100% [95–107%]. Infants (> 12 weeks), children, and young adults (< 18 years) develop similar characteristics of the staircase phenomenon than adults. Tetanic prestimulation prevents the staircase phenomenon in these age groups. The stability of the TOFR reading confirms its value to monitor neuromuscular function over time.

Registration: The study was registered as NCT02552875 on Clinical Trials.gov on July 29, 2014.

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Authors and Affiliations

  1. Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Christoph Unterbuchner, Markus Werkmann, Raphael Ziegleder, Stephanie Kraus, Timo Seyfried, Bernhard Graf, Barbara Sinner & Thomas Metterlein

  2. Centre for Clinical Studies, University Medical Centre, Regensburg, Germany

    Florian Zeman

  3. Department of Anaesthesiology and Intensive Care Medicine, Medical School, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany

    Manfred Blobner

Authors
  1. Christoph Unterbuchner
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  2. Markus Werkmann
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  4. Stephanie Kraus
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  6. Bernhard Graf
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  9. Barbara Sinner
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  10. Thomas Metterlein
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Corresponding author

Correspondence to Christoph Unterbuchner.

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Conflicts of interest

CU, MW, TM, RZ, SK, TS, BG, FZ, BS declare that they have no conflict of interest. MB received honoraria for board services and lectures from GE Health Care (Helsinki, Finland), MSD (Haar, Germany), and Grünenthal (Aachen, Germany).

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Ethics Committee,University of Regensburg, Regensburg, Germany; protocol No. 14-101-0114) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Unterbuchner, C., Werkmann, M., Ziegleder, R. et al. Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young adults (STSTS-Study): a prospective randomised, controlled trial. J Clin Monit Comput 34, 1343–1349 (2020). https://doi.org/10.1007/s10877-019-00435-4

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  • DOI: https://doi.org/10.1007/s10877-019-00435-4

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