Neuromuscular monitoring

In anesthesia, Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.

When train of four monitoring is "used continuously, each set (train) of stimuli normally is repeated every 10th to 12th second. Each stimulus in the train causes the muscle to contract, and 'fade' in the response provides the basis for evaluation." These sets are called trains because their shape bears the semblance of a train.^[1] In train of four monitoring, "peripheral nerve stimulation can ensure proper medication dosing and thus decrease the incidence of side effects" by "assessing the depth of neuromuscular blockade".^[2]

Before the patient is fully awake, voluntary muscle testing is not possible and indirect clinical tests, such as apparent muscle tone and pulmonary compliance, can be affected by factors other than PORC. Direct neuromuscular monitoring avoids these problems and allows the doctor to remedy PORC before it becomes a source of patient distress.^[3]^[4]^[5]^[6]^[7]

Nerve stimulator

Nerve stimulator

Modifizied mechanomyography. Electrodes on n. ulnaris

References

↑ "Train-of-Four Stimulation". Churchill Livingstone. 2000. Retrieved 10 September 2014.
↑ "Peripheral Nerve Stimulator - Train of Four Monitoring". Medscape. 12 July 2013. Retrieved 10 September 2014.
↑ Viby-Mogensen, Jorgen. "Neuromuscular Monitoring" (PDF). Retrieved 7 March 2013.
↑ Harvey AM, Masland RL: Actions of durarizing preparations in the human. Journal of Pharmacology And Experimental Therapeutics, Vol. 73, Issue 3, 304-311, 1941
↑ Botelho SY: Comparison of simultaneously recorded electrical and mechanical activity in myasthenia gravis patients and in partially curarized normal humans. Am J Med. 1955 Nov;19(5):693-6. PMID 13268466
↑ Christie TH, Churchill-Davidson HC: The St. Thomas's Hospital nerve stimulator in the diagnosis of prolonged apnoea. Lancet. 1958 Apr 12;1(7024):776. PMID 13526270
↑ Engbaek J, Ostergaard D, Viby-Mogensen J: Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block. Br J Anaesth. 1989 Mar;62(3):274-8. PMID 2522790

Anesthesia (outline)

Types	General Sedation Twilight anesthesia Local Topical Intercostal nerve block Neuraxial blockade Spinal Epidural Dental Inferior alveolar nerve

Techniques	Airway management Anesthesia provision in the US Arterial catheter Bronchoscopy Capnography Dogliotti's principle Drug-induced amnesia Intraoperative neurophysiological monitoring Nerve block Penthrox inhaler Tracheal intubation

Scientific Principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect

Measurements	ASA physical status classification system Baricity Bispectral index Direct Fick method Entropy monitoring Fick principle Goldman index Guedel's classification Mallampati score Neuromuscular monitoring Thyromental distance

Instruments	Anaesthetic machine Anesthesia cart Boyle's machine Gas cylinder Laryngeal mask airway Laryngeal tube Medical monitor Odom's indicator Relative analgesia machine Vaporiser Double-lumen endotracheal tube Endobronchial blocker

Complications	Emergence delirium Allergic reactions Anesthesia awareness Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization

Fields of study	Cardiothoracic Geriatric Oral sedation dentistry

Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating Department Practitioners Certified Anesthesia Technician Certified Anesthesia Technologist Anaesthetic technician

History	A.C.E. mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation

Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society

This article is issued from Wikipedia - version of the 5/27/2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.

Neuromuscular monitoring

References

Further reading