Comparison of kinemyography and electromyography during spontaneous recovery from non-depolarising neuromuscular blockade.
This study compared two commercially available quantitative neuromuscular function monitoring techniques, kinemyography (KMG) and electromyography (EMG), to assess whether KMG could be used interchangeably with EMG to exclude residual neuromuscular blockade (RNMB). Train-of-four (TOF) ratios were recorded every 20 seconds using KMG at the adductor pollicis and EMG at the first dorsal interosseous of the same hand during spontaneous recovery from shallow neuromuscular blockade. TOF ratios were compared using Bland-Altman analysis for repeated measurements. The precision of each device was assessed by the repeatability coefficient. Agreement between devices was assessed by the bias and limits of agreement. Clinically acceptable agreement was defined as a bias <0.025 within limits of agreement ±0.05. We recorded 629 sets of TOF ratios from 23 patients. The repeatability coefficient for KMG was 0.05 (95% confidence interval [CI] 0.05 to 0.06) and for EMG 0.10 (95% CI 0.10 to 0.11). Overall, the bias of KMG TOF ratios against EMG TOF ratios was 0.11 (95% CI 0.10 to 0.12), with limits of agreement -0.11 to 0.32. In the 0.80 to 0.99 TOF range, the bias was 0.08 (95% CI 0.06 to 0.09) and the limits of agreement were -0.12 to 0.27. Overall, TOF ratios measured by KMG were on average 0.11 higher than EMG. In the 0.80 to 0.99 TOF range, KMG TOF ratios were 0.08 higher. EMG and KMG are not interchangeable because the bias is large and the limits of agreement are wide. Thus a maximum TOF ratio of 1.0 on KMG may not exclude RNMB.
Medical Student, Faculty of Medicine, University of New South Wales, Sydney, New South Wales.
C
C
Khandkar
Junior Medical Officer, Conjoint Lecturer in Evidence Based Medicine, Statistician, Blacktown Hospital, School of Medicine, University of Western Sydney, New South Wales.
S
S
Liang
Consultant Anaesthetist, Associate Professor of Anaesthesia, Sydney Adventist Clinical School, Sydney Adventist Hospital, University of Sydney, Sydney, New South Wales.
S
S
Phillips
Junior Medical Officer, Hollywood Private Hospital, Perth, Western Australia.
C Y
CY
Lee
Clinical Senior Lecturer, Consultant Anaesthetist, Sydney Adventist Hospital Clinical School, Sydney Medical School, University of Sydney, New South Wales.
P A
PA
Stewart
D000368:Aged; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*
D003473:Neuromuscular Nondepolarizing Agents
neuromuscular blockade, kinemyography, electromyography, neuromuscular function monitoring