Posttetanic count revisited: are measurements more reliable using the TOF-Watch accelerographic peripheral nerve stimulator?
| Autor: | R. D. Vincent, Shannon L. Adkins, Russell C. Brockwell, Michael C. Moreno |
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| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Health Informatics Critical Care and Intensive Care Medicine Sensitivity and Specificity Intensive care Peripheral nerve stimulator medicine Humans Androstanols Rocuronium Muscle Skeletal Electrodes Aged Monitoring Physiologic Neuromuscular Blockade Tetany Electrical impedance myography business.industry Early recovery Myography Reproducibility of Results Middle Aged Neuromuscular monitoring Neuromuscular Nondepolarizing Agents Anesthesiology and Pain Medicine Anesthesia Transcutaneous Electric Nerve Stimulation Female business medicine.drug |
| Zdroj: | Journal of clinical monitoring and computing. 18(1) |
| ISSN: | 1387-1307 |
| Popis: | Objective.Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods.The TOF-Watch and Digi Stim III peripheral nerve stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results.Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator (p= NS). Among stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) (p< 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator (p< 0.05). Conclusions.Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients. |
| Databáze: | OpenAIRE |
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