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GENERAL ARTICLES

Assessing Residual Neuromuscular Blockade Using Acceleromyography Can Be Deceptive in Postoperative Awake Patients

Christophe Baillard, MD PhD^*, Sylvie Bourdiau, MD^*, Philippe Le Toumelin, MD^*, Farid Ait Kaci, MD^*, Bruno Riou, MD PhD, Michel Cupa, MD^*, and C. Marc Samama, MD PhD^*

*Department of Anesthesiology and Intensive Care, Avicenne Hospital, Bobigny; and Department of Emergency Medicine and Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France

Address correspondence and reprint requests to Dr. Christophe Baillard, Département d’Anesthésie-Réanimation, Hôpital Avicenne, 125 route de Stalingrad, 93009 Bobigny Cedex, France. Address email to christophe.baillard{at}avc.ap-hop-paris.fr

Postoperative awake patients may have significant residual neuromuscular block. In awake patients, the results of accelerometry are affected by extra movements to which the thumb may be subject. In this study, we evaluated the repeatability of train-of-four (TOF) ratio using acceleromyography in 253 patients recovering from anesthesia. Immediately after arrival in the postanesthesia care unit, the ulnar nerve was stimulated with TOF stimulation. The evoked response at the thumb was measured by the TOF-Watch apparatus. The current intensity was 30 mA. Two TOF stimulations were applied and recorded at 30-s intervals. A Bland-Altman test was used. The Kappa () test for clinical agreement between the two measurements was also calculated according to the presence or absence of a residual neuromuscular blockade, defined as a TOF ratio <0.9. According to the presence of a residual neuromuscular blockade, the paired TOF ratios were discordant in 61 patients (24%; 95% confidence interval, 21%–27%). The test indicated a moderate agreement (k = 0.47). We demonstrated that accelerometry as used in this study is not always accurate. Two isolated acceleromyograph TOF ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia.

IMPLICATIONS: Clinicians should be aware that acceleromyography as used in this study does not always provide precise train-of-four ratio measurements. Two isolated acceleromyograph train-of-four ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia.

This article has been cited by other articles:

				G. S. Murphy, J. W. Szokol, J. H. Marymont, S. B. Greenberg, M. J. Avram, and J. S. Vender Residual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit Anesth. Analg., July 1, 2008; 107(1): 130 - 137. [Abstract] [Full Text] [PDF]

				C. Baillard Assessment of Neuromuscular Blockade Using Acceleromyography Should Be Performed Before Emergence from Anesthesia Anesth. Analg., October 1, 2005; 101(4): 1247 - 1247. [Full Text] [PDF]

				P. E. Dubois, M. J. Gourdin, and J. Jamart Assessment of Neuromuscular Blockade Using Acceleromyography Should Be Performed Before Emergence from Anesthesia Anesth. Analg., October 1, 2005; 101(4): 1246 - 1247. [Full Text] [PDF]

				G. S. Murphy, J. W. Szokol, J. H. Marymont, M. Franklin, M. J. Avram, and J. S. Vender Residual Paralysis at the Time of Tracheal Extubation Anesth. Analg., June 1, 2005; 100(6): 1840 - 1845. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999