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A comparison of train‐of‐four monitoring: Mechanomyography at the thumb vs acceleromyographyat the big toe
Author(s) -
Heier T.,
Hetland S.
Publication year - 1999
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.1999.430511.x
Subject(s) - medicine , propofol , thumb , anesthesia , fentanyl , neuromuscular monitoring , onset of action , neuromuscular blockade , surgery
Background: It is not known if the information on neuromuscular function obtained from the hand is interchangeable with that of the foot. In the present study the agreement of thumb mechanomyography with acceleromyography of the big toe was studied. Methods: Ten healthy patients scheduled for oral surgery were studied. Anaesthesia was induced with fentanyl 2 μg kg −1 and propofol 2 mg kg −1 , and maintained with propofol 100–175 μg kg −1 min −1 , nitrous oxide 60–70%, and fentanyl 1–2 μg kg −1 h −1 . Vecuronium 0.1 mg kg −1 was used for muscle relaxation. Mechanomyography (MMG) of the thumb (Myograph 2000) and acceleromyography (AMG) of the big toe (TOF‐Guard) were recorded simultaneously in all patients, and onset, period of no‐twitch response, duration of action, and spontaneous recovery time obtained from both muscle groups. The agreement between methods was tested by calculation of bias and limits of agreement. Results: The onset time and duration of action were significantly shorter (87 s vs 154 s, and 35 min vs 38 min, respectively), and the spontaneous recovery time significantly longer in the thumb than in the big toe (32 min vs 19 min). Period of no‐twitch response was not significantly different in the two muscle groups. Limits of agreement (thumb big toe) were −21 to −113 s, −7 to 1 min, and −9 to 35 min, for onset time, duration of action, and spontaneous recovery time, respectively. Conclusion: We conclude that clinically acceptable agreement between thumb mechanomyography and big toe acceleromyography was found for the period of no‐twitch response, suggesting that the timing of supplemental doses of vecuronium can be guided by AMG at the big toe. However, the spontaneous recovery time agreement (to TOF ratio=0.75) between the thumb and the big toe was poor.