Quantitative Neuromuscular Monitoring: Current Devices, New Technological Advances, and Use in Clinical Practice
- 70 Downloads
Purpose of Review
The purpose of this review is to summarize various quantitative neuromuscular monitoring modalities and describe strategies to implement them into routine practice. We will contrast these objective modalities with unreliable clinical tests and subjective techniques that expose patients to unnecessary risk associated with postoperative residual weakness.
As major specialty societies publish guidelines and consensus statements urging anesthesiologists to utilize quantitative monitors, clinicians must familiarize themselves with this equipment. Furthermore, new monitors are emerging as the industry tries to address the need for user-friendly, reliable monitors.
Clinical assessment is an unacceptable technique to guide neuromuscular blockade management in patients receiving neuromuscular blocking agents. The use of a peripheral nerve stimulator can provide some information regarding the level of neuromuscular blockade in patients; however, it cannot reliably confirm adequate recovery. The use of objective, quantitative monitoring is an essential practice that helps guide the administration of neuromuscular blocking agents and excludes deleterious postoperative residual weakness.
KeywordsQuantitative monitoring Residual muscle weakness Neuromuscular blockade Patient safety
Compliance with Ethical Standards
Conflict of Interest
Hajime Iwasaki declares that he has no conflict of interest.
Reka Nemes is supported by a visiting student researcher grant from the J. William Fulbright Scholarship Board.
Sorin J. Brull has received research support through a grant from Merck (with funds to Mayo Clinic); has received compensation from Senzime AB for service on the Board of Directors; has served on scientific advisory boards for The Doctors Company, ClearLine MD, and NMD Pharma; and has a patent pending for neuromuscular display licensed to Mayo Clinic.
J. Ross Renew has received research support through a grant from Merck (with funds to Mayo Clinic).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors..
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Khuenl-Brady KS, Wattwil M, Vanacker BF, Lora-Tamayo JI, Rietbergen H, Álvarez-Gómez JA. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010;110(1):64–73.CrossRefPubMedGoogle Scholar
- 6.• Todd MM, Hindman BJ. The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department: follow-up observations. Anesth Analg. 2015;121(3):836–8. An excellent report which shows that the implementation of appropriate quantitative neuromuscular monitoring and staff education can eliminate major respiratory events associated with residual neuromuscular weakness. CrossRefPubMedGoogle Scholar
- 8.•• Checketts MR, Alladi R, Ferguson K, Gemmell L, Handy JM, Klein AA, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):85–93. A recent guideline from Great Britain and Ireland mandating the use of neuromuscular monitoring when NMBAs are administered. CrossRefPubMedGoogle Scholar
- 9.•• Naguib M, et al. Consensus statement on perioperative use of neuromuscular monitoring. Anesth Analg. 2017; https://doi.org/10.1213/ANE.0000000000002670. A recent consensus statement from the US mandating the use of neuromuscular monitoring when NMBAs are administered.
- 39.Johnson MA, Sideri G, Weightman D, Appleton D. A comparison of fibre size, fibre type constitution and spatial fibre type distribution in normal human muscle and in muscle from cases of spinal muscular atrophy and from other neuromuscular disorders. J Neurol Sci. 1973;20(4):345–61.CrossRefPubMedGoogle Scholar
- 43.Eriksson LI, Sundman E, Olsson R, Nilsson L, Witt H, Ekberg O, et al. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers. Anesthesiology. 1997;87(5):1035–43.CrossRefPubMedGoogle Scholar
- 93.Veiga Ruiz G, García Cayuela J, Orozco Montes J, Parreño Caparrós M, García Rojo B, Aguayo Albasini JL. Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): a comparative study with mechanomyography and invasive blood pressure. Revista espanola de anestesiologia y reanimacion. 2017;64(10):560–7.CrossRefPubMedGoogle Scholar