Conceptual and technical insights into the basis of neuromuscular monitoring

Anaesthesia

Volumn 72, Issue , 2017, Pages 16-37

  Naguib, M ^a   Brull, S J ^b   Johnson, K B ^c  

^a CLEVELAND CLINIC LERNER COLLEGE OF MEDICINE   (United States)

^b MAYO CLINIC   (United States)

^c UNIVERSITY OF UTAH SCHOOL OF MEDICINE   (United States)

Author keywords

monitoring neuromuscular function; neuromuscular blocking drugs; tetanic stimulation; train of four (TOF); twitch height

Indexed keywords

MUSCLE RELAXANT AGENT; NEUROMUSCULAR BLOCKING AGENT;

ACCELEROMYOGRAPHY; BREATHING MUSCLE; DOUBLE BURST STIMULATION; ELECTROMYOGRAPHY; FACE MUSCLE; HUMAN; KINEMYOGRAPHY; MECHANOMYOGRAPHY; MUSCLE WEAKNESS; MYOGRAPHY; NERVE STIMULATION; NEUROMUSCULAR BLOCKING; NEUROMUSCULAR MONITORING; PATIENT CARE; POST TETANIC TWITCH COUNT; PRACTICE GUIDELINE; REVIEW; SINGLE TWITCH STIMULATION; STIMULUS; SUPRAMAXIMAL STIMULATION; TETANIC STIMULATION; TRAIN OF FOUR STIMULATION; ELECTROSTIMULATION; PERIPHERAL NERVE; PHYSIOLOGY; PROCEDURES;

ELECTRIC STIMULATION; ELECTROMYOGRAPHY; HUMANS; NEUROMUSCULAR BLOCKADE; NEUROMUSCULAR MONITORING; PERIPHERAL NERVES; PRACTICE GUIDELINES AS TOPIC;

EID: 85007524275     PISSN: 00032409     EISSN: 13652044     Source Type: Journal    
DOI: 10.1111/anae.13738     Document Type: Review

References (103)

1. Hunter AR. Neostigmine-resistant curarization. British Medical Journal 1956; 2: 919–21.
2. Burchell GB, Lamont S. The application of a regime for the treatment of neostigmine resistant curatization. British Journal of Anaesthesia 1959; 31: 182–5.
3. Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive. Annals of Surgery 1954; 140: 2–35.
4. Christie TH, Churchill-Davidson HC. St. Thomas’ Hospital nerve stimulator in diagnosis of prolonged apnea. Lancet 1958; 271: 776.
5. Churchill-Davidson HC. The D-tubocurarine dilemma. Anesthesiology 1965; 26: 132–3.
6. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesthesia and Analgesia 2010; 111: 110–9.
7. Murphy GS, Szokol JW, Avram MJ, et al. Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period. Anesthesiology 2011; 115: 946–54.
8. Brull SJ, Naguib M. What we know: precise measurement leads to patient comfort and safety. Anesthesiology 2011; 115: 918–20.
9. Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology 1997; 86: 765–71.
10. Eriksson LI, Sundman E, Olsson R, 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: 1035–43.
11. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. British Journal of Anaesthesia 2007; 98: 302–16.
12. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesthesia & Analgesia 2008; 107: 130–7.
13. Brull SJ, Naguib M, Miller RD. Residual neuromuscular block: rediscovering the obvious. Anesthesia & Analgesia 2008; 107: 11–4.
14. Butterly A, Bittner EA, George E, Sandberg WS, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. British Journal of Anaesthesia 2010; 105: 304–9.
15. Todd MM. Sugammadex and residual neuromuscular block: what is acceptable normal practice? British Journal of Anaesthesia 2016; 116: 434–5.
16. Naguib M, Brull SJ, Arkes HR. Reasoning of an anomaly: residual block after sugammadex. Anesthesia & Analgesia 2013; 117: 297–300.
17. Kotake Y, Ochiai R, Suzuki T, et al. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesthesia & Analgesia 2013; 117: 345–51.
18. Batistaki C, Tentes P, Deligiannidi P, Karakosta A, Florou P, Kostopanagiotou G. Residual neuromuscular blockade in a real life clinical setting: correlation with sugammadex or neostigmine administration. Minerva Anestesiologica 2016; 82: 550–8.
19. Thomsen JL, Nielsen CV, Eskildsen KZ, Demant MN, Gatke MR. Awareness during emergence from anaesthesia: significance of neuromuscular monitoring in patients with butyrylcholinesterase deficiency. British Journal of Anaesthesia 2015; 115(Suppl 1): i78–88.
20. Pandit JJ, Andrade J, Bogod DG, et al. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Anaesthesia 2014; 69: 1089–101.
21. Checketts MR, Alladi R, Ferguson K, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2016; 71: 85–93.
22. Cerny V, Herold I, Cvachovec K, Sevcik P, Adamus M. Guidelines for managing neuromuscular block: not only Czech beer deserves a taste. Anesthesia & Analgesia 2011; 112: 482; author reply 3.
23. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225–30.
24. Baillard C, Clec'h C, Catineau J, et al. Postoperative residual neuromuscular block: a survey of management. British Journal of Anaesthesia 2005; 95: 622–6.
25. Todd MM, Hindman BJ, King BJ. The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department. Anesthesia & Analgesia 2014; 119: 323–31.
26. Cammu G, De Witte J, De Veylder J, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesthesia and Analgesia 2006; 102: 426–9.
27. Brull SJ, Silverman DG. Visual and tactile assessment of neuromuscular fade. Anesthesia & Analgesia 1993; 77: 352–5.
28. Heier T, Caldwell JE, Feiner JR, Liu L, Ward T, Wright PM. Relationship between normalized adductor pollicis train-of-four ratio and manifestations of residual neuromuscular block: a study using acceleromyography during near steady-state concentrations of mivacurium. Anesthesiology 2010; 113: 825–32.
29. Lu TC. Affinity of curare-like compounds and their potency in blocking neuromuscular transmission. Journal of Pharmacology and Experimental Therapeutics 1970; 174: 560–6.
30. Waud BE, Waud DR. The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology 1972; 37: 417–22.
31. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual Neuromuscular Block and Adverse Respiratory Events. Anesthesia & Analgesia 2008; 107: 1756.
32. Rocuronium Package Insert. http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/078717s000lbl.pdf (accessed 11/05/2016).
33. Schultz P, Ibsen M, Ostergaard D, Skovgaard LT. Onset and duration of action of rocuronium–from tracheal intubation, through intense block to complete recovery. Acta Anaesthesiologica Scandinavica 2001; 45: 612–7.
34. Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology 2003; 98: 1042–8.
35. Kirkegaard H, Heier T, Caldwell JE. Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block. Anesthesiology 2002; 96: 45–50.
36. Viby-Mogensen J. Correlation of succinylcholine duration of action with plasma cholinesterase activity in subjects with the genotypically normal enzyme. Anesthesiology 1980; 53: 517–20.
37. Gatke MR, Bundgaard JR, Viby-Mogensen J. Two novel mutations in the BCHE gene in patients with prolonged duration of action of mivacurium or succinylcholine during anaesthesia. Pharmacogenetics and Genomics 2007; 17: 995–9.
38. Ward S, Neill EA. Pharmacokinetics of atracurium in acute hepatic failure (with acute renal failure). British Journal of Anaesthesia 1983; 55: 1169–72.
39. Cook DR, Freeman JA, Lai AA, et al. Pharmacokinetics of mivacurium in normal patients and in those with hepatic or renal failure. British Journal of Anaesthesia 1992; 69: 580–5.
40. McNeal DR. Analysis of a model for excitation of myelinated nerve. IEEE Transactions on Biomedical Engineering 1976; 23: 329–37.
41. Kopman AF, Lawson D. Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology 1984; 61: 83–5.
42. Brull SJ, Silverman DG. Pulse width, stimulus intensity, electrode placement, and polarity during assessment of neuromuscular block. Anesthesiology 1995; 83: 702–9.
43. Harper NJ, Greer R, Conway D. Neuromuscular monitoring in intensive care patients: milliamperage requirements for supramaximal stimulation. British Journal of Anaesthesia 2001; 87: 625–7.
44. Winterhalter M, Munte S, Taschenbrecker P, et al. Skin impedance correlates to sedation grade, plasma propofol concentrations and bispectral index during a target-controlled infusion of propofol. European Journal of Anaesthesiology 2009; 26: 589–96.
45. Ali HH, Savarese JJ. Stimulus frequency and dose-respone curve to d-tubocurarine in man. Anesthesiology 1980; 52: 36–9.
46. Ali HH, Utting JE, Gray C. Stimulus frequency in the detection of neuromuscular block in humans. British Journal of Anaesthesia 1970; 42: 967–78.
47. Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block. I. British Journal of Anaesthesia 1971; 43: 473–7.
48. Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block. II. British Journal of Anaesthesia 1971; 43: 478–85.
49. Ramsey FM, Lebowitz PW, Savarese JJ, Ali HH. Clinical characteristics of long-term succinylcholine neuromuscular blockade during balanced anesthesia. Anesthesia & Analgesia 1980; 59: 110–6.
50. O'Hara DA, Fragen RJ, Shanks CA. Comparison of visual and measured train-of-four recovery after vecuronium-induced neuromuscular blockade using two anaesthetic techniques. British Journal of Anaesthesia 1986; 58: 1300–2.
51. Kopman AF, Mallhi MU, Justo MD, Rodricks P, Neuman GG. Antagonism of mivacurium-induced neuromuscular blockade in humans. Edrophonium dose requirements at threshold train-of-four count of 4. Anesthesiology 1994; 81: 1394–400.
52. Brull SJ, Ehrenwerth J, Silverman DG. Stimulation with submaximal current for train-of-four monitoring. Anesthesiology 1990; 72: 629–32.
53. Viby-Mogensen J, Howardy-Hansen P, Chraemmer-Jorgensen B, Ording H, Engbaek J, Nielsen A. Posttetanic count (PTC): a new method of evaluating an intense nondepolarizing neuromuscular blockade. Anesthesiology 1981; 55: 458–61.
54. Merton PA. Voluntary strength and fatigue. Journal of Physiology 1954; 123: 553–64.
55. Stanec A, Heyduk J, Stanec G, Orkin LR. Tetanic fade and post-tetanic tension in the absence of neuromuscular blocking agents in anesthetized man. Anesthesia & Analgesia 1978; 57: 102–7.
56. Kopman AF, Epstein RH, Flashburg MH. Use of 100-Hertz tetanus as an index of recovery from pancuronium-induced non-depolarizing neuromuscular blockade. Anesthesia & Analgesia 1982; 61: 439–41.
57. Brull SJ, Silverman DG. Tetanus-induced changes in apparent recovery after bolus doses of atracurium or vecuronium. Anesthesiology 1992; 77: 642–5.
58. Dupuis JY, Martin R, Tessonnier JM, Tetrault JP. Clinical assessment of the muscular response to tetanic nerve stimulation. Canadian Journal of Anaesthesia 1990; 37: 397–400.
59. Werba A, Klezl M, Schramm W, et al. The Level of Neuromuscular Block Needed to Suppress Diaphragmatic Movement during Tracheal Suction in Patients with Raised Intracranial-Pressure – a Study with Vecuronium and Atracurium. Anaesthesia 1993; 48: 301–3.
60. Fernando PU, Viby-Mogensen J, Bonsu AK, Tamilarasan A, Muchhal KK, Lambourne A. Relationship between posttetanic count and response to carinal stimulation during vecuronium-induced neuromuscular blockade. Acta Anaesthesiologica Scandinavica 1987; 31: 593–6.
61. Bonsu AK, Viby-Mogensen J, Fernando PU, Muchhal K, Tamilarasan A, Lambourne A. Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium. British Journal of Anaesthesia 1987; 59: 1089–92.
62. Tang Y, Zucker RS. Mitochondrial involvement in post-tetanic potentiation of synaptic transmission. Neuron 1997; 18: 483–91.
63. Naguib M, Flood P, McArdle JJ, Brenner HR. Advances in neurobiology of the neuromuscular junction: implications for the anesthesiologist. Anesthesiology 2002; 96: 202–31.
64. Xue L, Wu LG. Post-tetanic potentiation is caused by two signalling mechanisms affecting quantal size and quantal content. Journal of Physiology 2010; 588: 4987–94.
65. Bowman WC. Prejunctional and postjunctional cholinoceptors at the neuromuscular junction. Anesthesia & Analgesia 1980; 59: 935–43.
66. Faria M, Oliveira L, Timoteo MA, Lobo MG, Correia-De-Sa P. Blockade of neuronal facilitatory nicotinic receptors containing alpha3beta2 subunits contribute to tetanic fade in the rat isolated diaphragm. Synapse (New York, N. Y.) 2003; 49: 77–88.
67. Chang CC, Hong SJ. Dissociation of the end-plate potential run-down and the tetanic fade from the postsynaptic inhibition of acetylcholine receptor by alpha-neurotoxins. Experimental Neurology 1987; 98: 509–17.
68. Engbaek J, Ostergaard D, Viby-Mogensen J. Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block. British Journal of Anaesthesia 1989; 62: 274–8.
69. Drenck NE, Ueda N, Olsen NV, et al. Manual evaluation of residual curarization using double burst stimulation: a comparison with train-of-four. Anesthesiology 1989; 70: 578–81.
70. Schiaffino S, Gorza L, Sartore S, et al. Three myosin heavy chain isoforms in type 2 skeletal muscle fibres. Journal of Muscle Research and Cell Motility 1989; 10: 197–205.
71. Smith CE, Donati F, Bevan DR. Potency of succinylcholine at the diaphragm and at the adductor pollicis muscle. Anesthesia and Analgesia 1988; 67: 625–30.
72. Laycock JR, Donati F, Smith CE, Bevan DR. Potency of atracurium and vecuronium at the diaphragm and the adductor pollicis muscle. British Journal of Anaesthesia 1988; 61: 286–91.
73. Fisher DM, Szenohradszky J, Wright PM, Lau M, Brown R, Sharma M. Pharmacodynamic modeling of vecuronium-induced twitch depression. Rapid plasma-effect site equilibration explains faster onset at resistant laryngeal muscles than at the adductor pollicis. Anesthesiology 1997; 86: 558–66.
74. Ungureanu D, Meistelman C, Frossard J, Donati F. The orbicularis oculi and the adductor pollicis muscles as monitors of atracurium block of laryngeal muscles. Anesthesia & Analgesia 1993; 77: 775–9.
75. Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari MM, Bhananker SM. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology 2012; 117: 964–72.
76. Rosenberg H, Greenhow DE. Peripheral nerve stimulator performance: the influence of output polarity and electrode placement. Canadian Anaesthetists Society Journal 1978; 25: 424–6.
77. Donati F. Neuromuscular monitoring: more than meets the eye. Anesthesiology 2012; 117: 934–6.
78. Sopher MJ, Sears DH, Walts LF. Neuromuscular function monitoring comparing the flexor hallucis brevis and adductor pollicis muscles. Anesthesiology 1988; 69: 129–31.
79. Schreiber JU, Mucha E, Fuchs-Buder T. Acceleromyography to assess neuromuscular recovery: is calibration before measurement mandatory? Acta Anaesthesiologica Scandinavica 2011; 55: 328–31.
80. 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. European Journal of Anaesthesiology 2014; 31: 404–10.
81. Claudius C, Skovgaard LT, Viby-Mogensen J. Is the performance of acceleromyography improved with preload and normalization? A comparison with mechanomyography. Anesthesiology 2009; 110: 1261–70.
82. Kopman AF, Chin W, Cyriac J. Acceleromyography vs. electromyography: an ipsilateral comparison of the indirectly evoked neuromuscular response to train-of-four stimulation. Acta Anaesthesiologica Scandinavica 2005; 49: 316–22.
83. Brull SJ, Silverman DG. Real time versus slow-motion train-of-four monitoring: a theory to explain the inaccuracy of visual assessment. Anesthesia & Analgesia 1995; 80: 548–51.
84. Ali HH, Kitz RJ. Evaluation of recovery from nondepolarizing neuromuscular block, using a digital neuromuscular transmission analyzer: preliminary report. Anesthesia & Analgesia 1973; 52: 740–5.
85. Engbaek J. Monitoring of neuromuscular transmission by electromyography during anaesthesia. A comparison with mechanomyography in cat and man. Danish Medical Bulletin 1996; 43: 301–16.
86. Stewart PA, Freelander N, Liang S, Heller G, Phillips S. Comparison of electromyography and kinemyography during recovery from non-depolarising neuromuscular blockade. Anaesthesia and Intensive Care 2014; 42: 378–84.
87. Kopman AF. The effect of resting muscle tension on the dose-effect relationship of d-tubocurarine: does preload influence the evoked EMG? Anesthesiology 1988; 69: 1003–5.
88. Maybauer DM, Geldner G, Blobner M, et al. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia 2007; 62: 12–7.
89. Murphy GS, Szokol JW, Marymont JH, et al. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. Anesthesiology 2008; 109: 389–98.
90. Yip PC, Hannam JA, Cameron AJ, Campbell D. Incidence of residual neuromuscular blockade in a post-anaesthetic care unit. Anaesthesia and Intensive Care 2010; 38: 91–5.
91. Cammu GV, Smet V, De Jongh K, Vandeput D. A prospective, observational study comparing postoperative residual curarisation and early adverse respiratory events in patients reversed with neostigmine or sugammadex or after apparent spontaneous recovery. Anaesthesia and Intensive Care 2012; 40: 999–1006.
92. Kumar GV, Nair AP, Murthy HS, Jalaja KR, Ramachandra K, Parameshwara G. Residual neuromuscular blockade affects postoperative pulmonary function. Anesthesiology 2012; 117: 1234–44.
93. Norton M, Xara D, Parente D, Barbosa M, Abelha FJ. Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit. Revista Española de Anestesióloga y Reanimación 2013; 60: 190–6.
94. Esteves S, Martins M, Barros F, et al. Incidence of postoperative residual neuromuscular blockade in the postanaesthesia care unit: an observational multicentre study in Portugal. European Journal of Anaesthesiology 2013; 30: 243–9.
95. Pietraszewski P, Gaszynski T. Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium. Anaesthesiology Intensive Therapy 2013; 45: 77–81.
96. Fortier LP, McKeen D, Turner K, et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesthesia & Analgesia 2015; 121: 366–72.
97. Xara D, Santos A, Abelha F. Adverse respiratory events in a post-anesthesia care unit. Archivos de Bronconeumologia 2015; 51: 69–75.
98. Ledowski T, O'Dea B, Meyerkort L, Hegarty M, von Ungern-Sternberg BS. Postoperative residual neuromuscular paralysis at an Australian tertiary children's hospital. Anesthesiology Research and Practice 2015; 2015: 410248.
99. Brueckmann B, Sasaki N, Grobara P, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. British Journal of Anaesthesia 2015; 115: 743–51.
100. Cooper RA, Maddineni VR, Mirakhur RK, Wierda JM, Brady M, Fitzpatrick KT. Time course of neuromuscular effects and pharmacokinetics of rocuronium bromide (Org 9426) during isoflurane anaesthesia in patients with and without renal failure. British Journal of Anaesthesia 1993; 71: 222–6.
101. Plaud B, Proost JH, Wierda JM, Barre J, Debaene B, Meistelman C. Pharmacokinetics and pharmacodynamics of rocuronium at the vocal cords and the adductor pollicis in humans. Clinical Pharmacology and Therapeutics 1995; 58: 185–91.
102. Sheiner LB, Stanski DR, Vozeh S, Miller RD, Ham J. Simultaneous modeling of pharmacokinetics and pharmacodynamics: application to d-tubocurarine. Clinical Pharmacology and Therapeutics 1979; 25: 358–71.
103. Wierda JM, Kleef UW, Lambalk LM, Kloppenburg WD, Agoston S. The pharmacodynamics and pharmacokinetics of Org 9426, a new non-depolarizing neuromuscular blocking agent, in patients anaesthetized with nitrous oxide, halothane and fentanyl. Canadian Journal of Anaesthesia 1991; 38: 430–5.