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TOF-Watch NMB monitoring misleading display output during moderate neuromuscular blockade

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dc.contributor.authorCouto, Mafalda
dc.contributor.authorNunes, Catarina S.
dc.contributor.authorAmorim, Pedro
dc.contributor.authorMendes, Joaquim
dc.date.accessioned2021-11-24T09:38:10Z
dc.date.available2021-11-24T09:38:10Z
dc.date.issued2020
dc.descriptionMEDICON 2019. XV Conferência Mediterrânea sobre Engenharia Médica e Biológica e Computaçãopt_PT
dc.description.abstractIn general anesthesia, Neuromuscular Blockade (NMB) agents are administered to ensure intubation quality and complete immobilization. Monitoring NMB, based on the evoked response evaluation after a peripheral nerve stimulation, is essential to provide insight on medication dosing and suitable approaches for NMB reversal. Professionals often rely on the data displayed on the monitor screen after TOF stimuli, assuming measurements present the expected fade and a TOF-ratio > 90% is enough to rule out residual paralysis. This can be inaccurate and mislead the clinician to extubate before adequate NMB curarization. Data from 31 patients that underwent general anesthesia were retrospectively analyzed. All patients received a standard dose of rocuronium (0.6 mg/kg) for intubation, during maintenance additional rocuronium boluses were administered if solicited. NMB monitoring was done continuously applying TOF stimuli at the adductor pollicis with TOF-Watch SX®. Two types of monitoring display errors were studied: (1) valid TOF value without fade effect (invalid T1 > T2 > T3 > T4); (2) in the 30 min before extubation a valid TOF-ratio value > 90% (without error type 1) with T1 < 70%. Results show a mean (SD) of type 1 error on 42.0 (17.5)% of valid TOF measurements, type 2 error in 63 (45)%. Only 9 patients (29%) presented a TOF with no errors before extubation. These results may increase the distrust in the NMB monitoring devices, however its use should not be rejected when NMB agents are administered. Careful evaluation of the NMB is recommended and additional efforts should be placed in the accuracy of monitors data display to avoid errors.pt_PT
dc.description.abstractNa anestesia geral, agentes de bloqueio neuromuscular (BNM) são administrados para garantir a qualidade da intubação e a imobilização completa. O monitoramento do BNM, com base na avaliação da resposta evocada após uma estimulação do nervo periférico, é essencial para fornecer informações sobre a dosagem da medicação e abordagens adequadas para a reversão do BNM. Os profissionais geralmente contam com os dados exibidos na tela do monitor após os estímulos TOF, assumindo que as medições apresentam o desvanecimento esperado e uma relação TOF> 90% é suficiente para descartar paralisia residual. Isso pode ser impreciso e induzir o médico a extubar antes da curarização adequada do BNM. Os dados de 31 pacientes submetidos à anestesia geral foram analisados ​​retrospectivamente. Todos os pacientes receberam uma dose padrão de rocurônio (0,6 mg / kg) para intubação, durante a manutenção, bolus adicionais de rocurônio foram administrados, se solicitados. O monitoramento do BNM foi feito continuamente aplicando estímulos TOF no adutor do polegar com TOF-Watch SX®. Dois tipos de erros de exibição de monitoramento foram estudados: (1) valor TOF válido sem efeito de fade (T1> T2> T3> T4 inválido); (2) nos 30 min antes da extubação, um valor de razão TOF válido> 90% (sem tipo de erro 1) com T1 <70%. Os resultados mostram uma média (DP) de erro tipo 1 em 42,0 (17,5)% das medições válidas de TOF, erro tipo 2 em 63 (45)%. Apenas 9 pacientes (29%) apresentaram TOF sem erros antes da extubação. Esses resultados podem aumentar a desconfiança nos dispositivos de monitoramento de NMB, porém seu uso não deve ser rejeitado quando os agentes de NMB são administrados.pt_PT
dc.description.sponsorshipThis is a retrospective analysis of Clinical trial NCT02484651 data results, in which written and informed consent was obtained from all patients included in the study. Authors acknowledge the funding of projects LAETA and FCT-MIT Portugal PhD program (PD/BD/114378/2016).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationCouto M., Nunes C.S., Amorim P., Mendes J. (2020) TOF-Watch NMB Monitoring Misleading Display Output During Moderate Neuromuscular Blockade. In: Henriques J., Neves N., de Carvalho P. (eds) XV Mediterranean Conference on Medical and Biological Engineering and Computing – MEDICON 2019. MEDICON 2019. IFMBE Proceedings, vol 76. Springer, Champt_PT
dc.identifier.doi10.1007/978-3-030-31635-8_91pt_PT
dc.identifier.isbn978-3-030-31634-1 (Print)
dc.identifier.isbn978-3-030-31635-8 (Online)
dc.identifier.urihttp://hdl.handle.net/10400.2/11409
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringer Naturept_PT
dc.relationLeaders for Tevhnical Industries - LTI - Deep neuromuscular blckade monitoring: closed-loop monitor system for deep neuromuscular blockade during surgery
dc.subjectTOF-Watchpt_PT
dc.subjectTrain-of-fourpt_PT
dc.subjectNMB monitoringpt_PT
dc.titleTOF-Watch NMB monitoring misleading display output during moderate neuromuscular blockadept_PT
dc.typeconference object
dspace.entity.typePublication
oaire.awardTitleLeaders for Tevhnical Industries - LTI - Deep neuromuscular blckade monitoring: closed-loop monitor system for deep neuromuscular blockade during surgery
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/POR_NORTE/PD%2FBD%2F114378%2F2016/PT
oaire.citation.endPage775pt_PT
oaire.citation.startPage768pt_PT
oaire.citation.titleIFMBE Proceedingspt_PT
oaire.citation.volume76pt_PT
oaire.fundingStreamPOR_NORTE
person.familyNameCouto
person.familyNameNunes
person.familyNameAmorim
person.familyNameMendes
person.givenNameMafalda
person.givenNameCatarina S.
person.givenNamePedro
person.givenNameJoaquim
person.identifierR-000-7HY
person.identifier.ciencia-id691F-CDC2-E26A
person.identifier.ciencia-id301B-ED0C-A4FE
person.identifier.orcid0000-0002-4057-8355
person.identifier.orcid0000-0002-8357-0994
person.identifier.orcid0000-0001-7466-4174
person.identifier.orcid0000-0003-4254-1879
person.identifier.ridO-5655-2016
person.identifier.scopus-author-id55429654100
person.identifier.scopus-author-id35931916900
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsrestrictedAccesspt_PT
rcaap.typeconferenceObjectpt_PT
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