Monitoring Of Muscle Relaxation Research Articles

Examination of rapid adjustment system based on screen score obtained using continuous shear wave elastography.

Continuous shear wave elastography (C-SWE) can be expected to be applied to portable muscle elasticity diagnosis. To establish diagnostic technology, it will be necessary to improve measurement techniques and quantitative measurement accuracy. In this study, we investigated two screen scores: the quality index (Q-index), which determines whether the intensity of a power Doppler image is appropriate, and the shear wave propagation direction index (SWDI), which determines the uniformity of shear wave propagation. First, we performed numerical simulations with white noise and found that the coefficient of variation of shear wave velocity estimation was less than 5% when the normalized Q-index was greater than 0.27. Furthermore, regarding the SWDI, we clarified the relationship between the standard deviation in shear wave propagation direction and the SWDI. Next, the relationship between the Q-index and coefficient of variation of estimated shear wave velocity was evaluated through experiments using a tissue-mimicking phantom. The results showed that there was a negative correlation between the Q-index and the coefficient of variation, and the fluctuation of the propagation velocity could be inferred from the Q-index. Finally, we showed the results of applying the screen scores to muscle relaxation monitoring and confirmed its usefulness in clinical applications. By applying the screen scores, we showed improved stability in speed estimation in C-SWE, and demonstrated the possibility of clinical applicability.

Use of a combination of diaphragmatic ultrasound and muscle relaxation monitoring in predicting post-extubation adverse respiratory events among elderly patients in an anesthesia intensive care unit

ObjectiveThe purpose of this study was to examine the feasibility of using a combination of diaphragmatic ultrasound and muscle relaxation monitoring in predicting adverse respiratory events after extubation among elderly patients in an anesthetic intensive care unit (AICU).MethodsThe study participants were 120 elderly patients who were in the AICU after laparoscopic radical resection for colorectal cancer. Based on whether there were critical respiratory events (CREs) after extubation, they were divided into the adverse event group and the non-adverse event group. We used logistic regression to identify factors influencing the occurrence of CREs post-extubation in elderly patients. Using the receiver operating characteristic (ROC) curve, we analyzed the value of each indicator in predicting CREs post-extubation.ResultsWe included 109 patients in the final analysis. In the adverse event group (n = 19), the age, proportion of females, and proportion of preoperative respiratory diseases were higher than in the non-adverse event group (n = 90). The muscle relaxation value, quiet breathing diaphragmatic excursion during extubation (DE-QB), deep breathing diaphragmatic excursion during extubation (DE-DB), and deep breathing diaphragmatic thickening fraction during extubation (DTF-DB) of patients in the adverse event group were significantly lower than those in the non-adverse event group (P < 0.05). Using binary logistic regression analysis, we identified muscle relaxation value, DE-DB, and DTF-DB during extubation as significant predictors of CREs post-extubation in elderly patients (P < 0.05). The area under the curve (AUC) of the combination of the muscle relaxation value, DE-DB, and DTF-DB during extubation for predicting CREs after extubation in elderly patients was 0.949, which was higher than that of any single indicator.ConclusionThe combination of diaphragmatic ultrasound and muscle relaxation monitoring was more accurate in predicting CREs post-extubation among elderly patients in the AICU.

Effect of sugammadex on postoperative nausea and vomiting after surgery for intracranial aneurysm

Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),>0.5-2.0 hours(T2),>2.0-6.0 hours (T3),>6.0-12.0 hours (T4) and >12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). The results regarding the occurrence of complications in patients with different levels of PONV at different time intervals after surgery in the two groups were as follows: in the T3 time period of group N, a significant difference was observed only in the occurrence of postoperative complications among patients with different levels of PONV (χ2=24.786, P<0.01). However, in the T4 time period, significant differences were found in the occurrence of postoperative complications among both the same level and different level PONV patients (χ2=15.435, 15.435, both P<0.01). Significant differences were also observed in the occurrence of postoperative complications among the same level and different level PONV patients in both the T3 and T4 time periods of group S (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.

Muscle relaxation effect and safety of mivacurium in patients with early hepatocirrhosis

Objective To observe muscle relaxation effect and safety of mivacurium in hepatocirrhosis patients, and provide a guidance in its clinical application. Methods Candidates for elective laparoscopic surgery were divided into a hepatocirrhosis group(group C, n=32) and a non hepatocirrhosis group (group N, n=25). Muscular relaxation monitor was applied with a train of four stimulation(TOF). The intubation dosage was 0.2 mg/kg. Tracheal intubation was performed when train of four stimulation ratio(TOFr, T4∶T1) was 0, and pump infusion of mivacurium was started when muscle relaxation began to recover (TOFr>0) with a velocity of 0.6 mg·kg-1·h-1, which was switched to 0.3 mg·kg-1·h-1 and then stopped in 30 min and 20 min prior to end of suturing in group C and group N respectively. The key parameter included plasma cholinesterase(PchE) activity, histamine concentration, variation of MAP, HR, onset time of mivacurium, acting duration of the first dose, time of TOFr recovery, time from drug withdrawal to extubation, and recovery index. Results The PchE activity were(4 304±901) U/L and (6 227±1 289) U/L in two groups (P 0.05). The mean histamine concentrations of all patients were (0.196±0.020), (0.238±0.021), (0.278±0.024) μg/L prior to intravenous injection of mivacurium and in 5 min and 10 min post to injection, there were significant differences between the three times points(P 0.05). The duration of the first dose were(20±4) min and (16±3) min respectively, the recovery of TOFr to 75% were (35±10) min and (24±5) min, time from drug withdrawal to extubation were (35±9) min and (24±7) min, and there were significant differences between the two groups (P<0.05). Conclusions The plasma histamine concentration increase slightly without significant influence on MAP and HR, with satisfactory intubation conditions, good muscle relaxation and fast recovery from muscle relaxation when mivacurium was applied in patients with early hepatic cirrhosis. Compared with non hepatic cirrhosis patients, the time of muscle relaxation recovery induced by mivacurium was longer in hepatic cirrhosis patients, but compared with other muscle relaxant, it still had obvious advantages. Because mivacurium didn't directly depend on the liver to metabolize, so it could reduce the burden of liver on drug metabolism. It is recommended to be applied in patients with early hepatic cirrhosis. Key words: Cirrhosis of liver; Mivacurium chloride; Histamine; Cholinesterase; Monitoring of muscle relaxation

Monitoring of Muscle Relaxation in Routine Anesthesia Practice: Three-year Experience

Neuromuscular block is a really significant component of anesthesia during surgery operations. At this time, individual sensitivity to neuromuscular blocking differs considerably and depends on great number of factors. The main task of conduct of neuromuscular monitoring is exclusion of residual block and recovery of neuromuscular conductivity. We present analysis of three years’ experience of application of monitoring of neuromuscular conductivity. The aim of the research is the estimation of effectiveness of usage of monitoring of neuromuscular conductivity in daily practice of anesthesia service for provision of patients’ security and formation of comfortable conditions for surgeons’ work. Materials and methods. In our research, we included 4459 patients who had operating treatment under general anesthesia. All the patients were divided in two groups. In the first group (2355 patients) during anesthesia there used monitor TOF-Watch SX (Organon, Ireland). In the second group (2104 patients) monitoring of neuromuscular conductivity was not performed. Results. The received results lead to the conclusion that application of monitoring of neuromuscular conductivity allowed to decrease statistically number of incidents connected with insufficient neuromuscular blocking or impaired reversion of neuromuscular block. Absence of statistically considerable differences in quantity of hyperdynamic reactions in the circulatory system connected with intubation, probably, is caused by great quantity of heterogeneous factors of influence on this index. Also, application of monitor of neuromuscular conductivity made it possible to conform to a surgeon’s expectations, ensuring muscular relaxation suitable for surgery conditions. Conclusion. Usage of monitors of neuromuscular conductivity in routine anesthesia practice is necessary and essential for ensuring patients’ security and creation of comfortable conditions for surgeons work.

Comparison of clinical applications of single-dose intravenous injection of mivacurium and cisatracurium in adults’ vocalcordpolyps resection under self-retaining laryngoscope

Objective: Through comparing the clinical observation of mivacurium and cisatracurium in vocal polyp extraction, to study the advantage of mivacurium in vocal polyp extraction. Methods: Forty American Society of Anesthesiologists(ASA) physical status I~II patients for vocal polyp extraction, aged 18~60 years old, were randomly divided into two groups as Mivacurium injection group(Group M) and Cis-atracurium injection group(Group C), each group includes 20 subjects. None of the patients are allergic, has serious diseases of cardiovascular system, liver or kidney.None of them has asthma, airway high response, difficult airway or neuromuscular diseases.Those patients who use beta-blockers or calcium channel blockers for a long time were excluded .All the subjects had the same premedication, fasting and fluid fobidden time. All the subjects who get into the operating room get the routine monitoring of electrocardiogram(EEG), blood pressure(BP), heart rate(HR), pulse oxygen saturation(SpO2) and the TOF WATCH SX. Each group gives the same medicine other than the muscle relaxant during induction of general anesthesia to do the vocal polyp extraction by the same experienced operator. Two groups were recorded in each index of anesthesia induction and tracheal intubation conditions, operation conditions, anesthesia, muscle relaxation monitoring. Results: There are no statistically significant in Cormack-Lehane grading system,Cooper’s grading system and operation satifaction(p>0.05). 2. Group A have shorter intubation time than Group B(p 0.05). Conclusion: 1. A single intubating dose of mivacurium can provide similar intubation and surgeon satisfaction for the vocal polyp extraction. 2. Compared with cis-atracurium, mivacurium can shorten the intubation time and the recovery time of anesthesia. The adverse reactions of mivacurium is mild, and it has less Residual muscle relaxation. Therefore mivacurium is more suitable for the vocal polyp extraction than cis-atracurium.

SURGICAL MUSCLE RELAXATION

In Anesthesia practice neuromuscular blocking agents (muscle relaxants) areused for intubation and surgical muscle relaxation. The use of modern inhalational anestheticslike sevoflurane is commonly practiced in paediatric anesthesia for induction and endotrachealintubation. LMA (Laryngeal Mask Airway) is alternative to endotracheal intubation. It iscommonly used supraglotic device for the elective surgical procedures in adults and paediatricpopulation. We conducted this study to see whether sevoflurane produces enough surgicalmuscle relaxation so that the use of neuromuscular blocking agents can be avoided. StudyDesign: Observational study. Setting: King Khalid Hospital (KSA). Period: April 2013 toFebruary 2014. Material and Methods: 84 paediatric patients posted for elective surgicalprocedure were included. Regarding the adequacy of surgical muscle relaxation. Induction ofanesthesia was done with propofol 2mg/kg and Fentanyl 2 mcg/kg. Airway was maintained withLMA. Anesthesia was maintained by sevoflurane in oxygen and air. Blood pressure and Heartrate was kept with 20 % of baseline reading. Adequacy of surgical muscle relaxation was askedby the surgeon during surgery and was graded as good, fair or poor. Results: Mean age of thepatients was 2.4 year. There were 76 male and 8 female patients. 47 patients were operatedfor inguinal herniotomy, 32 for orchedopexy and 5 for umbilical herniotomy. Surgical musclerelaxation was good in all of the patients and none of them required use of muscle relaxants.Recovery of all patients was smooth. Discussion: Adequate surgical muscle relaxation isimportant to facilitate surgery. In paediatric population sevoflurane produces enough musclerelaxation for intubation and surgical muscle relaxation. Monitoring of muscle relaxation can beclinical as well as through muscle twitches. Conclusion: Our study showed that in paediatricpopulation

To study the adequacy of surgical muscle relaxation in paediatric patients scheduled for elective groin surgeries under general anesthesia using sevoflurane without using neuromuscular blocking agents

AbstractIntroduction:In Anesthesia practice neuromuscular blocking agents (muscle relaxants) are used for intubation and surgical muscle relaxation. The use of modern inhalational anesthetics like sevoflurane is commonly practiced in paediatric anesthesia for induction and endotracheal intubation. LMA is alternative to endotracheal intubation. It is commonly used supraglotic device for the elective surgical procedures in adults and paediatric population. We conducted this study to see whether sevoflurane produces enough surgical muscle relaxation so that the use of neuromuscular blocking agents can be avoided.Patients and Methods:84 paediatric patients of King Khalid Hospital (KSA) from April 2013 to February 2014 posted for elective surgical procedure were included in this observational study regarding the adequacy of surgical muscle relaxation. Induction of anesthesia was done with propofol 2mg/kg and Fentanyl 2 mcg/ kg. Airway was maintained with LMA. Anesthesia was maintained by sevoflurane in oxygen and air. Blood pressure and Heart rate was kept with 20% of baseline reading. Adequacy of surgical muscle relaxation was asked by the surgeon during surgery and was graded as good, fair or poor.Results:Mean age of the patients was 2.4 year. There were 76 male and 8 female patients. 47 patients were operated for inguinal herniotomy, 32 for orchedopexy and 5 for umbilical herniotomy. Surgical muscle relax-ation was good in all of the patients and none of them required use of muscle relaxants. Recovery of all patients was smooth.Discussion:Adequate surgical muscle relaxation is important to facilitate surgery. In paediatric population sevoflurane produces enough muscle relaxation for intubation and surgical muscle relaxation. Monitoring of muscle relaxation can be clinical as well as through muscle twitches.Conclusion:Our study showed that in paediatric population the elective surgical procedures of groin region can be done without using muscle relaxants.Keywords:Paediatric anesthesia, LMA, neuromuscular blocking agents, surgical muscle relaxation.

Management Principles to Reduce the Risk of Residual Neuromuscular Blockade

The perioperative use of neuromuscular blocking agents has revolutionized medicine, and has allowed numerous and significant advances in the surgical management of patients. However, surgical advancement has not been devoid of attendant complications such as intraoperative patient recall, residual neuromuscular weakness, pulmonary aspiration of gastric contents, and need for tracheal reintubation. This chapter briefly reviews the various ways in which clinicians can optimize the timing and dosing of muscle relaxants, improve perioperative monitoring of muscle relaxation, and enhance the pharmacologic reversal of neuromuscular block. These strategies are intended to reduce the incidence of postoperative neuromuscular weakness and improve the safety of patients undergoing surgery and general anesthesia.

Improving Pharmacokinetic–Pharmacodynamic Models of Muscle Relaxants Using Potentiation Modelling

Repeated motor nerve stimulation performed during neuromuscular monitoring enhances the evoked mechanical response of the corresponding muscle resulting in an increased twitch response. This is known as twitch potentiation or the staircase phenomenon. For neuromuscular modelling research twitch stabilisation techniques are often used to reduce the visible effect of potentiation, but such techniques are not always effective. Our objective was to model pharmacokinetic-pharmacodynamic (PK-PD) and twitch potentiation and to estimate neuromuscular block (NMB) in the presence of twitch potentiation. We combined a standard PK-PD model with a model describing the degree of twitch potentiation. The combined model was used to predict mechanomyographic twitch measurements and estimate NMB and twitch potentiation during muscle relaxation monitoring. Model parameters and prediction accuracy were compared to the standard PK-PD model with and without linear baseline correction. The PK-PD-potentiation model allows NMB to be estimated in the presence of twitch potentiation. It also accurately predicts data from twitch stabilisation, which is ignored with the standard PK-PD model. Compared to the standard PK-PD model, estimated PD parameters ec50 and gamma were found to be higher using the PK-PD-potentiation model. Compared to linear baseline correction, estimated PD parameters ke0 and ec50 were found to be higher. A PK-PD-potentiation model can estimate the degree of twitch potentiation and the degree of NMB during neuromuscular monitoring. This model leads to different PD parameter estimations than the standard PK-PD model however the differences are small enough to be unlikely to cause great concern among researchers.

Rocuronium Onset at the Adductor Pollicis and Masseter Muscles for Endotracheal Intubation in Children

Background: Masseter muscle is a better predictor of good intubating conditions than adductor pollicis after the administration of rocuronium in adults. We compared the onset of rocuronium at the masseter muscle to that at the adductor pollicis to determine which is the more suitable predictor of good intubating conditions using rocuronium in children. Methods: Fifty children aged from 1 to 6 years old, were anesthetized with thiopental sodium and sevoflurane. The ulnar nerve was stimulated to monitor the relaxation of the adductor pollicis, and the mandibular nerve for monitoring masseter muscle relaxation. Rocuronium 0.6 mg/kg was administered. We measured the time to maximal blckade of the masseter muscle (M-0%). We recorded the percentage of relaxation of the adductor pollicis (AP-%) at M-0% and the time of the maximal blockade of the adductor pollicis (AP-0%), from the administration of rocuronium. Endotracheal intubation was started when the masseter muscle contraction was maximally blocked. Results: M-0% occurred at 37.4 15.4 s, and AP-% was 32.4 32.2% at M-0%. AP-0% occurred at 54.8 19.0 s. The time gap between M-0% and AP-0% was 16.8 18.3 s. Intubation was at 64.4 19.4 s from the administration of rocuronium. Conclusions: The time gap between M-0% and AP-0% was very short in children. Therefore, the monitoring of muscle relaxation on masseter muscle is not straightforward, and therefore, not advised.

Optimal surface electrode positioning for reliable train of four muscle relaxation monitoring.

In the clinic, a major problem in train of four (TOF) muscle relaxation monitoring is incorrect placement of stimulation and recording electrodes, frequently resulting in incorrect estimates of the patient's degree of relaxation or in abandonment of relaxation monitoring. The aim of this study was to arrive at recommendations that describe how to find optimal positions for the electrodes, where 'optimal' is taken in the sense that small deviations from these positions introduce no or only a small decline in the accuracy of the computed degree of muscle relaxation. This study, which employed the Relaxograph as the stimulation and measuring device, established that incorrect positioning is a real problem that frequently occurs; that the correctness of positioning is not guaranteed when the calibration of the Relaxograph succeeds; that the inadequacy of the electrode position is sometimes discovered for the first time when relaxation deepens; that positioning errors can be discovered by analysing the shape of the evoked compound action potential (ECAP), not only upon calibration but also when relaxation deepens; that a set of optimal electrode positions can be found; and that recommendations of how to find these optimal positions could help clinicians to place the electrodes in such a way, that reliable relaxation monitoring was possible in 100% of the investigated cases. In a first test in 30 adult patients, we surveyed how clinicians routinely positioned electrodes and found that in 14 of the 30 cases positioning was unsuccessful. In a second test in 10 patients, we tested a variety of electrode positions in order to discover 'optimal' stimulation, recording and ground electrode sites. In a third test in 10 patients, electrodes were positioned at these 'optimal' sites; stimulation and recording at these sites was successful in all 10 cases.

筋弛緩のモニター 筋弛緩薬によるＴＯＦＲの相違

筋弛緩のモニター 筋弛緩薬によるＴＯＦＲの相違

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筋弛緩のモニター 単収縮反応の応用

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筋弛緩のモニター テタヌス刺激による反応の利用

筋弛緩のモニター テタヌス刺激による反応の利用

筋弛緩のモニター 新しいモニターと刺激法 （１） Ａｃｃｅｌｅｒａｔｉｏｎ ＴｒａｎｓｄｕｃｅｒとＴｅｔａｎｉｃ Ｃｏｕｎｔ

筋弛緩のモニター 新しいモニターと刺激法 （１） Ａｃｃｅｌｅｒａｔｉｏｎ ＴｒａｎｓｄｕｃｅｒとＴｅｔａｎｉｃ Ｃｏｕｎｔ

筋弛緩のモニター 臨床症状とモニターの関係

筋弛緩のモニター 臨床症状とモニターの関係

Instrument for automatic monitoring of muscle relaxation of a patient

Instrument for automatic monitoring of muscle relaxation of a patient