Normalization of the acceleromyographic train-of-four
[Show abstract] [Hide abstract] ABSTRACT: Residual weakness in our post-anesthesia-care-units (PACU) following the intra-operative administration of non-depolarizing neuromuscular blocking agents continues to be a frequent and usually unrecognized occurrence. If satisfactory recovery from these drugs is defined as a train-of-four ratio (TOF) of 0.90 or greater, probably not less than 30 % of patients fail to achieve this level of recovery upon arrival in the PACU. While most health young individuals will tolerate TOF values of 0.70 with no serious sequelae, this is not true of all patients. The elderly and patients with pre-existing conditions such as COPD, asthma, sleep apnea, obesity, and muscle or neurological disease may not be so fortunate. Anesthesia and surgery in the absence of muscle relaxant administration still cause major reductions in pulmonary reserve. The additional combination of residual block, and the contributing factors listed above are a recipe for post-op pulmonary complications.0Comments 0Citations
- "In as much as control acceleromyographic (AMG) TOF values exceed electromyographic (EMG) ratios by 0.10–0.15 [6, 37, 38] , this study nicely confirms the observations of Baumüller [34 @BULLET ]. A displayed (not normalized) AMG value of 1.0 or an EMG value of 0.90 represents full clinical recovery. "
[Show abstract] [Hide abstract] ABSTRACT: Satisfactory recovery from nondepolarizing neuromuscular block is currently defined as return of the train-of-four ratio at the adductor pollicis muscle to a value of 0.90 or greater. Studies in volunteers demonstrate that train-of-four ratios of 0.70–0.80 are associated not only with subjective symptoms of weakness, but also dysfunction of the muscles of airway patency and swallowing. There is ample evidence that a sizeable proportion of patients who receive nondepolarizing neuromuscular blocking agents return to postanesthesia care units with undetected postoperative residual neuromuscular block (postoperative muscle weakness). However, until recently, outcome studies that demonstrate that postoperative weakness may be associated with adverse patient outcomes have been lacking. This review is an attempt to collate the available data that suggest that even modest levels of residual block have untoward clinical consequences.0Comments 2Citations
- "On the basis of these recent data, there is now a general consensus that adequate recovery from nondepolarizing neuromuscular block is not assured until the TOF ratio (measured by mechanomyography or electromyography) at the adductor pollicis muscle is equal to or greater than 0.90. When acceleromyography (AMG) is used, some investi- gators  suggest that a value of 1.00 should be used; however, normalized AMG values of 0.90 are equally acceptable [44, 45]. "
- "Train of Four Vol. 60, No. 5, May 2011 stabilization is needed to minimize this, and the results require correction by comparing them with pre-experiment and postexperiment values8910. Choosing the wrong nerve to be stimulated can result in an exaggerated evaluation of the state of muscle relaxation recovery. "
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