Neuromuscular monitoring is critical for the judicious use of muscle relaxants. In combination with reversal, it is fundamental to every successful strategy for managing postoperative residual blocks. This reference work is a compendium of all the essential information needed to monitor neuromuscular function. Physiological and pharmacological basics of neuromuscular transmission, principles of neuromuscular monitoring: How to place stimulation electrodes, properly select the stimulation mode and interprete findings, practical techniques for clinical routine, clinical concepts behind qualitative and quantitative nerve stimulators, comprehensive presentation of acceleromyography including a question & answer section, summaries of all key points, current guidelines on the scientific use of acceleromyography.
Author(s): Thomas Fuchs-Buder
Edition: 1st Edition.
Publisher: Springer
Year: 2010
Language: English
Pages: 224
Neuromuscular Monitoring in Clinical Practice and Research......Page 1
Front-matter......Page 2
Title Page
......Page 4
Copyright Page
......Page 5
Foreword......Page 6
Preface......Page 8
Table of Contents......Page 10
List of abbreviations......Page 14
1 Principles of neuromuscular transmission......Page 16
Neuromuscular endplate......Page 17
1.1.2 Action potential......Page 19
Storage and release......Page 20
Structure......Page 22
Activation......Page 23
1.1.5 Presynaptic nicotinic acetylcholine receptors......Page 24
Electromechanical coupling......Page 25
Mechanism of action......Page 26
Features of non-depolarizing blockades......Page 27
Safety margin......Page 28
Sequence of neuromuscular blockade......Page 29
Features of depolarization blockades......Page 30
Mechanism of action......Page 31
Indirectaction......Page 32
Representative compounds......Page 33
Mechanism of action......Page 34
References......Page 37
2 Principles of neuromuscular monitoring......Page 38
Supramaximal current......Page 39
2.2 Stimulation electrodes......Page 41
Direct muscle stimulation......Page 43
2.3 Stimulation site/test muscle......Page 45
2.3.1 Ulnar nerve/adductorpollicis muscle......Page 46
2.3.2 Posterior tibial nervelflexor hallucis brevis muscle......Page 47
2.3.3 Facial nerve/orbicularis occuli muscle or facial nerve/corrugator supercilii muscle......Page 48
2.4 Anesthesia-relevant muscle groups......Page 52
2.4.1 Diaphragm......Page 53
2.4.3 Abdominal muscles......Page 54
2.4.5 Pharyngeal muscles......Page 55
2.5 Stimulation patterns......Page 56
2.5.1 Single twitch......Page 57
2.5.2 Train-of-four......Page 58
2.5.3 Double-burst stimulation......Page 64
2.5.4 Tetanic stimulation......Page 66
2.5.5 Post-tetanic count......Page 68
2.6.1 Simple nerve stimulators......Page 71
2.6.2 Quantitative nerve stimulators......Page 74
Mechanomyography......Page 75
Electromyography......Page 76
Acceleromyography......Page 78
Phonomyography......Page 81
Kinemyography......Page 83
References......Page 85
3 Clinical application......Page 88
3.1 Neuromuscular monitoring during anesthesia induction......Page 91
3.1.1 Neuromuscular blocking agents for anesthesia induction?......Page 92
Test muscles......Page 97
Stimulation patterns......Page 100
3.1.3 What level of neuromuscular block for intubation?......Page 102
3.2 Intraoperative application of neuromuscular monitoring......Page 105
3.2.1 Accumulation of NMBAs......Page 106
3.2.2 Stimulation patterns and test muscles......Page 110
Complete neuromuscular recovery?......Page 112
Pulmonary muscles......Page 113
Respiratory control......Page 114
Safety margin......Page 116
Patient comfort......Page 117
Minimal residual neuromuscular blockade......Page 119
Upper airway function during adequate neuromuscular recovery......Page 120
3.3.2 Frequency of residual neuromuscular blockade......Page 121
3.3.3 Clinical implications associated with residual neuromuscular blockade......Page 123
Paradoxical respiration or jerky, uncontrolled movements of the extremities......Page 125
Tongue depressor test......Page 126
Stimulation patterns......Page 127
Testmuscles......Page 128
3.3.5 Prevention strategies for residual neuromuscular blockade......Page 129
Qualitative neuromuscular monitoring......Page 130
Quantitative neuromuscular monitoring......Page 132
References......Page 135
4 Acceleromyography......Page 139
4.1 Principles......Page 141
4.2 The Accelograph and the TOF-Guard......Page 142
4.3.1 The TOF ratio algorithm......Page 145
4.3.2 Calibration modes......Page 148
4.3.3 Nerve localization in regional anesthesia procedures......Page 151
4.4.1 Short set-up instructions......Page 153
4.4.2 Brief overview......Page 154
4.4.3 Scheme of buttons and display symbols......Page 155
Alarms......Page 162
Settings......Page 164
4.5.1 Short set-up instructions......Page 165
4.5.2 Brief overview......Page 166
4.5.3 Scheme of buttons and display symbols......Page 167
Starting up the TOF-Watch® S......Page 169
Selecting the stimulation mode......Page 171
Alarms......Page 174
Settings......Page 176
4.6.1 Short set-up instructions......Page 179
4.6.2 Brief overview......Page 180
4.6 .3 Scheme of buttons and display symbols......Page 181
Starting up the TOF-Watch® SX......Page 183
Selecting the stimulation mode......Page 185
Alarms......Page 189
Settings......Page 191
4.7.1 Canacceleromyography alsobe usedin infants?......Page 194
4.7.2 Isneuromuscular monitoring painful for patients?......Page 195
4.7.3 What to observe when attaching TOF-Watch® nerve stimulators?......Page 197
4.7.4 Is calibration really necessary?......Page 199
4.7.5 Can neuromuscular monitoring with the TOF-Watch® nerve stimulator prevent residual blockade?......Page 205
4.8 Acceleromyography in research......Page 208
Stimulation patterns......Page 209
Calibration......Page 210
Intubation conditions......Page 211
Choice of materials......Page 212
4.8.3 Guidelines for measuring onset and time profile of neuromuscular blockade......Page 213
Onset of action/onset time......Page 214
Concluding remarks......Page 215
References......Page 217
Subject Index......Page 220
