Volume : VI, Issue : IV, April - 2017

Comparison between objective methods (TOF watch Sx) versus subjective method (Peripheral nerve stimulator) to monitor nondepolarising neuromuscular blockade

Nagaraja Reddy, Aloka Samantaray, M. Hanumantha Rao

Abstract :

 Acceleromyograph (AMG) is the gold standard for neuromuscular monitoring but at present, peripheral nerve stimulator (PNS) is mostly used in routine clinical settings. Our aim is to compare the accuracy of visual assessment (subjective) of the TOF responses using a PNS with that of AMG using TOF watch Sx, which is a reproducible method (objective) of measurement.

Patients and methods: Sixty patients scheduled to undergo elective surgery under general endotracheal anaesthesia with neuromuscular blocking drugs were enrolled in this cross over study. TOF–Watch SX (Organon, Swords, Dublin Co., Ireland) or a PNS (innervator272, fisher&paykelhealthcare, Auckland, Newzeland) applied to each hand randomly.  After induction of anaesthesia, vecuronium 0.1 mg/kg was injected while TOF stimulations were applied every 12 s at the wrist site until maximal blockade. Tracheal intubation was performed after registration of zero on TOF watch or complete abolition of twitch response on PNS whichever comes late. Intubating condition and time to intubaton was observed by an independent anaesthesiologist. Degree of agreement was analysed with   Bland and Altman plot.

Results:                             The time to register zero on PNS is earlier compared to those patients monitored by AMG [PNS, 92.8(27.42); TOF watch SX, 142.6(27.4); p=0.001). The mean difference of the measurements between AMG and PNS methods is 49.8 seconds (95% limits of agreement 88.2, 11.4 sec).

Conclusions:                    We found that there is a considerable lack of agreement between the AMG and PNS, with discrepancies of up to 77 second.

 

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Nagaraja Reddy, Aloka Samantaray, M.Hanumantha Rao, Comparison between objective methods (TOF watch Sx) versus subjective method (Peripheral nerve stimulator) to monitor nondepolarising neuromuscular blockade, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : VOLUME-6 | ISSUE-4 | APRIL‾2017

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