Comparison between acceleromyography and visual assessment of train-of-four for monitoring neuromuscular blockade in horses undergoing surgery.
Abstract: To compare acceleromyography (AMG) with visual assessment of train-of-four (TOF) for monitoring neuromuscular blockade and detecting residual muscle paralysis in horses receiving atracurium. Methods: Prospective, controlled clinical study. Methods: Nine adult, client-owned horses weighing 577 (436, 727) kg (median, minimum, maximum) and ASA physical status I-II, admitted for surgery. Methods: An electrical nerve stimulator was used to stimulate the peroneal nerve with TOFs at 1 minute intervals. Before and after atracurium administration (0.15 mg kg(-1), IV), the number of twitches observed (TOF count, or TOFc) was assessed visually. When four twitches were seen (i.e., TOFc = 4) presence or absence of fade by visual assessment was recorded. Simultaneously, the response to each TOF was assessed by AMG; this measured TOFc, and twitch fade using TOF ratio (TOFR; ratio of fourth to first twitch). The anesthetist performing the visual evaluation was blinded to the AMG readings. Recovery from neuromuscular blockade was defined as the absence of fade by visual inspection or a TOFR > or =90% by AMG. Results: During onset of action of the drug, fade was first detected 4 (1, 8) minutes earlier by AMG (p = 0.008). Maximal blockade started at 6 (3, 17) minutes by visual assessment and 9 (3, 25) minutes by AMG (not significantly different). Only four horses achieved complete neuromuscular blockade (TOFc of zero by both methods); in those four horses AMG did not detect the start of the return of neuromuscular transmission before visual assessment. Visual assessment indicated the return of four twitches with no fade 12 (8, 42) minutes before AMG gave a TOFR of > or =90% (p = 0.004). Conclusions: There was no substantial advantage for AMG in detecting the onset of atracurium-induced neuromuscular blockade. However, AMG detected residual blockade when visual assessment of TOF did not. Application of AMG is likely to reduce the incidence of residual blockade.
Publication Date: 2008-02-18 PubMed ID: 18282252DOI: 10.1111/j.1467-2995.2007.00380.xGoogle Scholar: Lookup
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- Comparative Study
- Controlled Clinical Trial
- Journal Article
- Anesthesia
- Clinical Examination
- Clinical Findings
- Clinical Pathology
- Clinical Study
- Comparative Study
- Diagnosis
- Diagnostic Technique
- Disease Diagnosis
- Disease Treatment
- Equine Health
- Horses
- Muscle
- Myography
- Neuromuscular System
- Pharmacology
- Physiology
- Surgery
- Veterinary Medicine
- Veterinary Procedure
- Veterinary Research
Summary
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The research article is a comparative clinical study investigating how effective acceleromyography (AMG) is versus visual assessment of train-of-four (TOF) in monitoring neuromuscular blockade and detecting residual paralysis in horses that have received atracurium.
Research Methodology
- The study was conducted prospectively and in a controlled manner.
- Nine adult client-owned horses weighing between 436 and 727 kg with ASA physical status I-II were chosen for the project and monitored during surgery.
- An electrical nerve stimulator was used to stimulate the peroneal nerve at one-minute intervals while the response to each stimulation was recorded by both visual assessment of TOF and AMG.
- TOF assessment included a count of the number of twitch frequencies and the presence or absence of fading, while AMG measured these as well as the TOF ratio (TOFR)—the ratio of the fourth to the first twitch.
- The anesthetist observing the TOF count (TOFc) was not made aware of the corresponding AMG readings to ensure impartial results.
Results of the Study
- The onset of action of the drug through fade detection was first identified 4 minutes earlier by AMG than by visual assessment, a statistically significant difference.
- However, the initiation of maximum blockade was almost identical in both methods, with a slight delay in detection using the AMG method, though not determined significant.
- Total neuromuscular blockage was observed in only four of the horses, and AMG did not detect the return of neuromuscular transmission any quicker than visual assessment.
- Despite this, AMG detected the return of non-fading twitches twelve minutes prior to the TOFR reaching 90% or greater—another significant result.
Conclusions Drawn
- While the beginning of atracurium-induced neuromuscular blockade was not dramatically more noticeable with AMG as compared to visual assessment, AMG did show greater effectiveness in detecting remaining blockage when visual evaluation did not.
- Based on these findings, it is suggested that AMG might be a beneficial tool in reducing instances of residual blockade in similar clinical scenarios.
Cite This Article
APA
Martin-Flores M, Campoy L, Ludders JW, Erb HN, Gleed RD.
(2008).
Comparison between acceleromyography and visual assessment of train-of-four for monitoring neuromuscular blockade in horses undergoing surgery.
Vet Anaesth Analg, 35(3), 220-227.
https://doi.org/10.1111/j.1467-2995.2007.00380.x Publication
Researcher Affiliations
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA. mm459@cornell.edu
MeSH Terms
- Anesthesia Recovery Period
- Anesthetics / pharmacology
- Animals
- Electromyography / veterinary
- Female
- Horses
- Male
- Muscle Contraction / drug effects
- Muscle, Skeletal / drug effects
- Neuromuscular Blockade / veterinary
- Neuromuscular Blocking Agents / pharmacology
- Observer Variation
Citations
This article has been cited 3 times.- Motamed C. Intraoperative Monitoring of Neuromuscular Blockade.. Life (Basel) 2023 May 15;13(5).
- Gindrat AD, Quairiaux C, Britz J, Brunet D, Lanz F, Michel CM, Rouiller EM. Whole-scalp EEG mapping of somatosensory evoked potentials in macaque monkeys.. Brain Struct Funct 2015 Jul;220(4):2121-42.
- Lorenzutti AM, Martin-Flores M, Baldivieso JM, Himelfarb MA, Litterio NJ. Evaluation of neostigmine antagonism at different levels of vecuronium-induced neuromuscular blockade in isoflurane anesthetized dogs.. Can Vet J 2014 Feb;55(2):156-60.
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