Predictive value of mechanomyography and accelerometry for pulmonary function in partially paralyzed volunteers.
BACKGROUND
Accelerometry (ACM) of adductor pollicis muscle has been used for monitoring of neuromuscular blockade but its validity compared with the gold standard, mechanomyography (MMG), has been questioned. During neuromuscular blockade we compared these methods and we assessed pulmonary function.


METHODS
In awake partially paralyzed volunteers we spirometrically assessed pulmonary function every 5 min until recovery. Rocuronium (0.01 mg kg(-1) + 2-10 microg kg(-1) min(-1)) was administered to maintain train-of-four (TOF)-ratios (assessed every 15 s) of approximately 0.5 and 0.8 over a period of more than 5 min. The TOF-ratio associated with 'acceptable' pulmonary recovery [forced vital capacity (FVC) and forced inspiratory volume in 1 s (FIV1) of > or =90% of baseline] was calculated using a linear regression model. During 5-min periods of repetitive nerve stimulation we compared the squared residuals of the FVC and FIV1 estimates from TOFACM vs. TOFMMG, and compared variance of values derived from ACM and MMG using Wilcoxon's test.


RESULTS
Limits of agreement of TOF-ratio derived from ACM and MMG were wide [0.15+/-0.016 (SD)], and variability of TOFACM exceeded that of TOFMMG[variance: 77+/-105 vs. 51+/-55% (P<0.01)]. Calculated TOF(ACM) and TOFMMG ratios of 0.56 (0.22-0.71) [mean (95%CI) and 0.6 (0.28-0.74)], respectively, predict 'acceptable' (90%) recovery of FVC while FIV1 remains impaired until TOF-ratios of 0.91 (0.82-1.07) and 0.95 (0.82-1.18), respectively. In turn, TOFMMG (TOFACM) of unity predicted 'acceptable' recovery of FVC and FIV1 in 94 (93) % and 68 (73) % of measurements, respectively.


CONCLUSIONS
Accelerometry predicts effects of relaxation on pulmonary function as valid as the gold standard mechanomyography. We recommend that recovery of TOF ratio to 0.9-1.0 should be used as an indication of sufficient neuromuscular recovery in daily practice.
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany. matthias.eikermann@uni-essen.de
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Eikermann
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Groeben
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Hüsing
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Peters
D000328:Adult; D000732:Androstanols / Q000008:administration & dosage; D004558:Electric Stimulation; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D016014:Linear Models; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D009119:Muscle Contraction / Q000187:drug effects; D009213:Myography / Q000379:methods; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012129:Respiratory Function Tests; D000077123:Rocuronium; D013147:Spirometry; D018709:Statistics, Nonparametric; D013933:Thumb / Q000294:innervation; D014459:Ulnar Nerve / Q000187:drug effects; D014797:Vital Capacity / Q000187:drug effects
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium