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TECHNOLOGY, COMPUTING, AND SIMULATION

Phonomyography and Mechanomyography Can Be Used Interchangeably to Measure Neuromuscular Block at the Adductor Pollicis Muscle

From the Neuromuscular Research Group (NRG), Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal (CHUM) Hôtel-Dieu, Université de Montréal, Montréal, Canada

Address correspondence and reprint requests to T. M. Hemmerling, MD, DEAA, Department of Anesthesiology, Université de Montréal, Hôtel-Dieu, 3580 Rue St. Urbain, Montréal (Québec) H2W 1T8, Canada. Address email to thomashemmerling{at}hotmail.com

The standard of neuromuscular monitoring is the measurement of the force of contraction (mechanomyography, MMG). Phonomyography (PMG) consists of recording low-frequency sounds created during muscle contraction. In this study, we compared and used both methods to determine neuromuscular blockade (NMB) at the adductor pollicis muscle. In 14 patients, PMG was recorded via a small condenser microphone taped to the thenar mass, and a standard mechanomyographic device was applied to the same arm. In another group of 14 patients, only PMG was measured. After induction of anesthesia, the ulnar nerve was stimulated supramaximally using single twitch stimulation (0.1 Hz) for onset and train-of-four (TOF) stimulation every 12 s during offset of NMB produced by mivacurium 0.1 mg/kg. Onset and recovery indices measured by the 2 methods were compared using Student’s t-test (P < 0.05). Similar comparisons were made between the two PMG groups (with or without special board). Agreement between PMG and MMG was examined using a Bland-Altman test. Onset was 165 (68) s versus 172 (67) s [mean (SD)], and maximum blockade was 89 (10)% versus 90 (11)%, for PMG and MMG respectively (NS). Time to 25%, 75%, and 90% recovery was 16.5 (4.2) min, 22.1 (6.9) min, and 24.5 (8.2) min, respectively for PMG, not different from 16.7 (4) min, 22.8 (8.1) min, and 24.8 (8.8) min for MMG. Mean bias was 0% with limits of agreement of -10 and + 10% of twitch height for all signals (MMG minus PMG). Time to TOF of 0.5, 0.7, 0.8, and 0.9, was 1 min faster with PMG than with MMG, with limits of agreement of -1.5 to 3.5 min. Pharmacodynamic data derived without or with special arm fixation were not significantly different. MMG and PMG can be used interchangeably to determine NMB at the adductor pollicis muscle. PMG is easier to apply, does not need a special monitoring board and could be a reliable monitor to determine NMB in daily routine.

IMPLICATIONS: Mechanomyography and phonomyography (PMG), a novel method of monitoring neuromuscular blockade (NMB) by recording low-frequency sounds emitted by muscle contraction, can be used interchangeably to determine NMB at the adductor pollicis muscle. PMG is easier to apply, does not need a special monitoring board and could be a reliable monitor to determine NMB in daily routine.

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