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Validity and Tolerability of Awake Calibration of an Accelerometer Neuromuscular Monitor

  • Roger Hulley
  • Dec 15, 2022
  • 1 min read

Updated: Jul 6, 2023


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Silvia Pozza, M.D.; Daniele Speciale, M.D.; Sina Grape, M.D., M.B.A.; Sander M. J. van Kuijk, Ph.D.; Sorin J. Brull, M.D., F.C.A.R.C.S.I. (Hon.); Christoph Czarnetzki, M.D., M.B.A.

Anesthesiology Newly Published on October 2022. | https://doi.org/10.1097/ALN.0000000000004377


Abstract

Acceleromyography is the most commonly used quantitative neuromuscular monitoring method.1 Current guidelines recommend calibration of acceleromyographic devices for scientific purposes by setting monitor gain and defining supramaximal current.2,3 Calibration is rarely performed in clinical practice.3,4 Without calibration, the gain of the monitor may be set too low, and one or more responses to train-of-four stimulation may be outside the measurement window and will not be displayed, underestimating recovery.3 Even in calibrated devices, however, acceleromyography may report baseline train-of-four ratios as high as 130 to 140%; therefore, comparison of final train-of-four ratio to the baseline train-of-four ratio (normalization) is also recommended.5 Baseline calibration generally is performed after anesthesia induction but before the administration of neuromuscular blocking agents. In a rapid sequence induction and intubation setting, or during studies that involve awake patients, clinicians and investigators may opt to forgo calibration, to shorten the time that patients are at risk for pulmonary aspiration, or to avoid additional patient stress and discomfort. We investigated the validity and tolerability of calibration of the TOF-Watch SX monitor (Organon, Ireland) in awake patients compared to calibration in anesthetized patients.

 
 
 
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