دورية أكاديمية
Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis.
| العنوان: | Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis. |
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| المؤلفون: | Tobias JD; From the Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, The Ohio University, Columbus, Ohio., Epstein RH; Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miami, Florida., Rice-Weimer J; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio., Yemele Kitio SA; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio., Brull SJ; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida., Kalsotra S; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio. |
| المصدر: | Anesthesia and analgesia [Anesth Analg] 2024 Jul 01; Vol. 139 (1), pp. 36-43. Date of Electronic Publication: 2024 Jun 17. |
| نوع المنشور: | Journal Article; Comparative Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 1310650 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-7598 (Electronic) Linking ISSN: 00032999 NLM ISO Abbreviation: Anesth Analg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 1998- : Baltimore, Md. : Lippincott Williams & Wilkins Original Publication: Cleveland, International Anesthesia Research Society. |
| مواضيع طبية MeSH: | Electromyography*/methods , Muscle, Skeletal*/innervation , Muscle, Skeletal*/physiology , Neuromuscular Blockade*/methods, Humans ; Male ; Female ; Prospective Studies ; Child, Preschool ; Child ; Infant ; Foot ; Electric Stimulation ; Ulnar Nerve ; Hand/innervation ; Neuromuscular Blocking Agents/administration & dosage ; Neuromuscular Monitoring/methods ; Tibial Nerve |
| مستخلص: | Background: Peripheral nerve stimulation with a train-of-four (TOF) pattern can be used intraoperatively to evaluate the depth of neuromuscular block and confirm recovery from neuromuscular blocking agents (NMBAs). Quantitative monitoring can be challenging in infants and children due to patient size, equipment technology, and limited access to monitoring sites. Although the adductor pollicis muscle is the preferred site of monitoring, the foot is an alternative when the hands are unavailable. However, there is little information on comparative evoked neuromuscular responses at those 2 sites. Methods: Pediatric patients undergoing inpatient surgery requiring NMBA administration were studied after informed consent. Electromyographic (EMG) monitoring was performed simultaneously in each participant at the hand (ulnar nerve, adductor pollicis muscle) and the foot (posterior tibial nerve, flexor hallucis brevis muscle). Results: Fifty patients with a mean age of 3.0 ± standard deviation (SD) 2.9 years were studied. The baseline first twitch amplitude (T1) of TOF at the foot (12.46 mV) was 4.47 mV higher than at the hand (P <.0001). The baseline TOF ratio (TOFR) before NMBA administration and the maximum TOFR after antagonism with sugammadex were not different at the 2 sites. The onset time until the T1 decreased to 10% or 5% of the baseline value (T1) was delayed by approximately 90 seconds (both P =.014) at the foot compared with the hand. The TOFR at the foot recovered (TOFR ≥0.9) 191 seconds later than when this threshold was achieved at the hand (P =.017). After antagonism, T1 did not return to its baseline value, a typical finding with EMG monitoring, but the fractional recovery (maximum T1 at recovery divided by the baseline T1) at the hand and foot was not different, 0.81 and 0.77, respectively (P =.68). The final TOFR achieved at recovery was approximately 100% and was not different between the 2 sites. Conclusions: Although this study in young children demonstrated the feasibility of TOF monitoring, interpretation of the depth of neuromuscular block needs to consider the delayed onset and the delayed recovery of TOFR at the foot compared to the hand. The delay in achieving these end points when monitoring the foot may impact the timing of tracheal intubation and assessment of adequate recovery of neuromuscular block to allow tracheal extubation (ie, TOFR ≥0.9). Competing Interests: Conflicts of Interest: See Disclosures at the end of the article. (Copyright © 2024 International Anesthesia Research Society.) |
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| معلومات مُعتمدة: | N/A Senzime AB |
| سلسلة جزيئية: | ClinicalTrials.gov NCT04475250 |
| المشرفين على المادة: | 0 (Neuromuscular Blocking Agents) |
| تواريخ الأحداث: | Date Created: 20240617 Date Completed: 20240617 Latest Revision: 20240617 |
| رمز التحديث: | 20240619 |
| DOI: | 10.1213/ANE.0000000000006926 |
| PMID: | 38885397 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1526-7598 |
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| DOI: | 10.1213/ANE.0000000000006926 |