A comparison of train-of-four monitoring: mechanomyography at the thumb vs acceleromyography at the big toe.
BACKGROUND
It is not known if the information on neuromuscular function obtained from the hand is interchangeable with that of the foot. In the present study the agreement of thumb mechanomyography with acceleromyography of the big toe was studied.


METHODS
Ten healthy patients scheduled for oral surgery were studied. Anaesthesia was induced with fentanyl 2 micrograms kg-1 and propofol 2 mg kg-1, and maintained with propofol 100-175 micrograms kg-1 min-1, nitrous oxide 60-70%, and fentanyl 1-2 micrograms kg-1 h-1. Vecuronium 0.1 mg kg-1 was used for muscle relaxation. Mechanomyography (MMG) of the thumb (Myograph 2000) and acceleromyography (AMG) of the big toe (TOF-Guard) were recorded simultaneously in all patients, and onset, period of no-twitch response, duration of action, and spontaneous recovery time obtained from both muscle groups. The agreement between methods was tested by calculation of bias and limits of agreement.


RESULTS
The onset time and duration of action were significantly shorter (87 s vs 154 s, and 35 min vs 38 min, respectively), and the spontaneous recovery time significantly longer in the thumb than in the big toe (32 min vs 19 min). Period of no-twitch response was not significantly different in the two muscle groups. Limits of agreement (thumb big toe) were -21 to -113 s, -7 to 1 min, and -9 to 35 min, for onset time, duration of action, and spontaneous recovery time, respectively.


CONCLUSIONS
We conclude that clinically acceptable agreement between thumb mechanomyography and big toe acceleromyography was found for the period of no-twitch response, suggesting that the timing of supplemental doses of vecuronium can be guided by AMG at the big toe. However, the spontaneous recovery time agreement (to TOF ratio = 0.75) between the thumb and the big toe was poor.
Heier
T
T
Department of Anesthesia, Ullevål University Hospital, Oslo, Norway.
Hetland
S
S
D000054:Acceleration; D000328:Adult; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006214:Hallux / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology; D018482:Muscle, Skeletal / Q000187:drug effects / Q000294:innervation; D009213:Myography / Q000379:methods*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D013933:Thumb / Q000294:innervation*; D013979:Tibial Nerve / Q000187:drug effects*; D013997:Time Factors; D014459:Ulnar Nerve / Q000187:drug effects*; D014673:Vecuronium Bromide / Q000008:administration & dosage
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D009609:Nitrous Oxide; D005283:Fentanyl; D015742:Propofol