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The interest of 100 versus 200 Hz tetanic stimulations to quantify low levels of residual neuromuscular blockade with mechanomyography: a pilot study

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Abstract

A more sensitive method than the train-of-four ratio seems required to detect low levels of residual neuromuscular blockade before tracheal extubation. The goal of the study was to determine the potential benefit of 5 s of 100 versus 200 Hz tetanic stimulation to quantify the residual block with mechanomyography in anesthetised patients. Twenty informed and consenting 18- to 80-year-old patients undergoing nose surgery were included. On the left hand, neuromuscular transmission was continuously monitored by acceleromyography. On the right side, a new mecanomyographic device (Isometric Thumb Force©) recorded the force of thumb adduction (N) developed during 5 s of 100- and 200 Hz tetanic stimulations of the ulnar nerve at three consecutive times: baseline before inducing the neuromuscular blockade, at the time of contralateral train-of-four ratio 0.9 recovery, and 3 min after additional sugammadex reversal. Tetanic Fade Ratios (TFR = F residual/F max) were compared between 100 and 200 Hz stimulations using Student’s t test. At the time of TOF ratio 0.9 recovery, both 100 and 200 Hz TFR were significantly decreased compared to baseline (0.61 and 0.16 on average, respectively, p < 0.0001). The 200 Hz TFR was significantly lower than the 100 Hz TFR (p < 0.0001). There were no differences between baseline and post-reversal TFR. The 200 Hz TFR has the potential to better describe low levels of residual neuromuscular blockade than the TOF ratio and 100 Hz TFR and would benefit from further investigations. Retrospectively registered in the Australian and New Zealand Clinical Trials Registry ACTRN12619000273189.

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Notes

  1. This prototype device stems from the Laboratory of Microengineering and Bioinstrumentation—HEPIA/inSTI—University of Applied Sciences Western Switzerland (HES-SO Geneva), Campus Biotech, Chemin des Mines 9, CH-1202 Geneva, Switzerland. philippe.passeraub@hesge.ch / fabien.moreillon@hesge.ch.

References

  1. Naguib M, Brull SJ, Kopman AF, et al. Consensus statement on perioperative use of neuromuscular monitoring. Anesth Analg. 2018;127:71–80.

    Article  Google Scholar 

  2. Mencke T, Echternach M, Kleinschmidt S, et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003;98:1049–56.

    Article  CAS  Google Scholar 

  3. Madsen M, Staehr-Rye AK, Gätke MR, Claudius C. Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery: a systematic review. Acta Anaesthesiol Scand. 2015;59:1–16.

    Article  CAS  Google Scholar 

  4. Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg. 2010;111:129–40.

    Article  Google Scholar 

  5. Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anaesthesia. Anesthesiology. 2010;112:1013–22.

    Article  Google Scholar 

  6. Viby-Mogensen J, Jensen E, Werner M, Nielsen HK. Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand. 1988;32:45–8.

    Article  CAS  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  Google Scholar 

  8. Capron F, Alla F, Hottier C, Meistelman C, Fuchs-Buder T. Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9. Anesthesiology. 2004;100:1119–24.

    Article  Google Scholar 

  9. Kirmeier E, Eriksson LI, Lewald H, et al. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study. Lancet Respir Med. 2019;7:129–40.

    Article  Google Scholar 

  10. Gissen AJ, Katz RL. Twitch, tetanus and posttetanic potentiation as indices of nerve-muscle block in man. Anesthesiology. 1969;30:481–7.

    Article  CAS  Google Scholar 

  11. Waud BE, Waud DR. The relation between tetanic fade and receptor occlusion in the presence of competitive neuromuscular block. Anesthesiology. 1971;35:456–64.

    Article  CAS  Google Scholar 

  12. Stanec A, Heyduk J, Stanec G, Orkin LR. Tetanic fade and post-tetanic tension in the absence of neuromuscular blocking agents in anesthetized man. Anesth Analg. 1978;57:102–7.

    Article  CAS  Google Scholar 

  13. Kopman AF, Epstein RH, Flashburg MH. Use of 100-Hertz tetanus as an index of recovery from pancuronium-induced non-depolarizing neuromuscular blockade. Anesth Analg. 1982;61:439–41.

    Article  CAS  Google Scholar 

  14. Ali HH, Savarese JJ, Lebowitz PW, Ramsey FM. Twitch, tetanus and train-of-four as indices of recovery from nondepolarizing neuromuscular blockade. Anesthesiology. 1981;54:294–7.

    Article  CAS  Google Scholar 

  15. Passeraub P, Moreillon F, D’Hollander A, inventors; University of Applied Sciences HEPIA (HES-SO Geneva), assignee. 2016, Nov 25, Medical Device, Kit and Method for Sensing a Thumb Compression Force, Patent Application No. WO2018096077A1. https://patentscope.wipo.int/search/fr/detail.jsf?docId=WO2018096077&_cid=P21-K3RA8B-95513-1

  16. Dubois PE, De Bel M, Jamart J, et al. Performance of acceleromyography with a short and light TOF-tube compared with mechanomyography. A clinical comparison. Eur J Anaesthesiol. 2014;31:404–10.

    Article  Google Scholar 

  17. 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  Google Scholar 

  18. Silverman DG, Brull SJ. The effect of a tetanic stimulus on the response to subsequent tetanic stimulation. Anesth Analg. 1993;76:1284–7.

    Article  CAS  Google Scholar 

  19. Baurain MJ, Hoton F, Dernovoi BS, d’Hollander AA. Influence and relative sensitivities of 50-Hz and 100-Hz tetanic stimuli on subsequent tetanic fade ratios in patients receiving vecuronium. Anesth Analg. 1996;82:139–42.

    Article  CAS  Google Scholar 

  20. D’Hollander A, Duvaldestin P, Delcroix C, Nevelsteen M, Desmondts JM. Evolution of single twitch, train of four responses and of tetanic fade in relation to plasma concentrations of fazadinium in man. Anesth Analg. 1982;61:225–30.

    PubMed  Google Scholar 

  21. Dupuis JY, Martin R, Tessonnier JM, Tétrault JP. Clinical assessment of the muscular response to tetanic nerve stimulation. Can J Anaesth. 1990;37:397–400.

    Article  CAS  Google Scholar 

  22. Miller RD, Eger IE, Way WL, Stevens WC, Dolan WM. Comparative neuromuscular effects of Forane and halothane alone and in combinaison with d-tubocurarine in man. Anesthesiology. 1971;35:38–42.

    Article  CAS  Google Scholar 

  23. Waud BE, Waud DR. The relation between the response to “train-of-four” stimulation and receptor occlusion during competitive neuromuscular block. Anesthesiology. 1972;37:413–6.

    Article  CAS  Google Scholar 

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Funding

This work was supported by the Department of Anesthesiology and Scientific Support Unit of CHU UCL Namur site Godinne and benefited from a grant from the Fondation pour l’Anesthésie et la Réanimation (FAR), a philanthropic non-governmental organization founded in 1972, Vaduz, Principality of Lichtenstein.

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Authors and Affiliations

  1. Université catholique de Louvain, CHU UcL Namur, Site Godinne, Avenue Dr G. Therasse, 1, 5530, Yvoir, Belgium

    Philippe E. Dubois, John Mitchell & Maxime Regnier

  2. Laboratory of Microengineering and Bioinstrumentation, HEPIA - University of Applied Sciences Western Switzerland (HES-SO Geneva), Geneva, Switzerland

    Philippe A. Passeraub, Fabien Moreillon & Alain A. d’Hollander

Authors
  1. Philippe E. Dubois
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  2. John Mitchell
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  3. Maxime Regnier
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  4. Philippe A. Passeraub
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  5. Fabien Moreillon
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  6. Alain A. d’Hollander
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Contributions

All authors contributed to the study conception and design. Material preparation was performed by PAP, FM and AAd’. Data collection was performed by PED and JM. Data analysis was performed by MR. The first draft of the manuscript was written by PED and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Philippe E. Dubois.

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Conflict of interest

Alain A D’Hollander is the President of the Fondation pour l’Anesthésie et la Réanimation (FAR) which granted this study. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Institutional Ethical Committee (CHU UCL Namur, Yvoir, Belgium, OM 050 Prof P. Evrard, under registration number 54/2017 B039201732500). Retrospectively included in the Australian and New Zealand Clinical Trials Registry (ACTRN12619000273189).

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All patients provided written informed consent to participate to the study and for results publication.

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Dubois, P.E., Mitchell, J., Regnier, M. et al. The interest of 100 versus 200 Hz tetanic stimulations to quantify low levels of residual neuromuscular blockade with mechanomyography: a pilot study. J Clin Monit Comput 36, 1131–1137 (2022). https://doi.org/10.1007/s10877-021-00745-6

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  • DOI: https://doi.org/10.1007/s10877-021-00745-6

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