Unterbuchner, Christoph and Blobner, Manfred and Puehringer, Friedrich and Janda, Matthias and Bischoff, Sebastian and Bein, Berthold and Schmidt, Annette and Ulm, Kurt and Pithamitsis, Viktor and Fink, Heidrun (2017) Development of an algorithm using clinical tests to avoid post-operative residual neuromuscular block. BMC ANESTHESIOLOGY, 17: 101. ISSN 1471-2253,
Full text not available from this repository. (Request a copy)Abstract
Background: Quantitative neuromuscular monitoring is the gold standard to detect postoperative residual curarization (PORC). Many anesthesiologists, however, use insensitive, qualitative neuromuscular monitoring or unreliable, clinical tests. Goal of this multicentre, prospective, double-blinded, assessor controlled study was to develop an algorithm of muscle function tests to identify PORC. Methods: After extubation a blinded anesthetist performed eight clinical tests in 165 patients. Test results were correlated to calibrated electromyography train-of-four (TOF) ratio and to a postoperatively applied uncalibrated acceleromyography. A classification and regression tree (CART) was calculated developing the algorithm to identify PORC. This was validated against uncalibrated acceleromyography and tactile judgement of TOF fading in separate 100 patients. Results: After eliminating three tests with poor correlation, a model with four tests (r = 0.844) and uncalibrated acceleromyography (r = 0.873) were correlated to electromyographical TOF-values without losing quality of prediction. CART analysis showed that three consecutively performed tests (arm lift, head lift and swallowing or eye opening) can predict electromyographical TOF. Prediction coefficients reveal an advantage of the uncalibrated acceleromyography in terms of specificity to identify the EMG measured train-of-four ratio < 0.7 (100% vs. 42.9%) and < 0.9 (89.7% vs. 34.5%) compared to the algorithm. However, due to the high sensitivity of the algorithm (100% vs. 94.4%), the risk to overlook an awake patient with a train-of-four ratio < 0.7 was minimal. Tactile judgement of TOF fading showed poorest sensitivity and specifity at train of four ratio < 0.9 (33.7%, 0%) and <0.7 (18.8%, 16.7%). Conclusions: Residual neuromuscular blockade can be detected by uncalibrated acceleromyography and if not available by a pathway of four clinical muscle function tests in awake patients. The algorithm has a discriminative power comparable to uncalibrated AMG within TOF-values >0.7 and <0.3.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PARTIALLY PARALYZED HUMANS; POSTANESTHESIA CARE-UNIT; QUANTITATIVE ASSESSMENT; ANTIDEPOLARIZING BLOCK; ADDUCTOR POLLICIS; ACCELEROMYOGRAPHY; RECOVERY; SUGAMMADEX; REVERSAL; CURARIZATION; Postoperative residual curarization; electromyography; acceleromyography; algorithm; clinical muscle function tests |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:16 |
| Last Modified: | 25 Feb 2019 18:36 |
| URI: | https://pred.uni-regensburg.de/id/eprint/1394 |
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