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Comparison between the Clinical Assessment, Peripheral Nerve Stimulation (PNS), and Acceleromyography (AMG) to Reverse Neuromuscular Blockade

Authors: Iyad Abbas Salman --- Mortada A. Jubara
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 146-152
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية


ABSTRACT: BACKGROUND:Traditionally, most of anesthesiologists in Iraq evaluate the degree of neuromuscular blockade during and after anesthesia using clinical criteria alone, which are inaccurate to assess adequate recovery from neuromuscular block (NMB) which is essential for the patient to have full control of pharyngeal and respiratory muscles. Fade cannot be detected reliably with a peripheral nerve stimulator (PNS) at a TOF ratio > 0.4. The time gap between losses of visual fade by using a PNS until objective TOF ratio has returned to > 0.90 can be considered “the potentially unsafe period of recovery.” OBJECTIVE: To compare between assessment of subjective clinical, subjective TOF by peripheral nerve stimulation (PNS), and objective TOF by acceleromyography (AMG) before reversal of neuromuscular blockadePATIENT AND METHOD: A prospective clinical trial of one hundred females who underwent caesarian section under general anesthesia. Standard anesthesia was conducted for all patients. Giving of neuromuscular reversal was decided by the anesthesia care providers depending on clinical criteria, at that time, TOF measured by 2 ways, 1st: counting the twitches visually (principal of PNS), and 2nd: the device showing the TOF reading objectively (principal of AMG).RESULT: Comparisons between subjective criteria and objective AMG T4T1 ratios revealed no statistical significance (P > 0.05) in all comparisons (except that with the moving limb and lift the head). The association and consistency of subjective criteria and visual PNS was insignificant differences in all comparisons. There was wide discrepancy between objective reading and the visual PNS. CONCLUSION: The moving limbs and sustained lift head 5 seconds clinical criteria were correlated to TOF. Other criteria (protruding tongue, respiratory effort, and swallowing reflex) were not correlated to TOF. Objective AMG more sensitive to detect the fourth twitch than the subjective PNS. KEY WORDS: train of four (TOF), peripheral nerve stimulator (PNS).

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