Relaxation

Can monitoring of neuromuscular function become a new standard for clinical routine?

Johann Motsch, M.D.

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Monitoring of vital functions is an essential part of anesthesia care. Therefore, monitoring standards have been established to improve patient safety and to decrease perioperative morbidity and mortality. Twenty years ago the Dutch government implemented standards for intraoperative monitoring by law and in addition standards were developed for patient monitoring during anesthesia at the Havard Medical School, so that monitoring standards for safe anesthesia practice are now available worldwide. These guidelines also recommend monitoring of neuromuscular function and although routine use of monitoring cardiovascular function and pulse oximetry are accepted generally, monitoring neuromuscular function has not yet become a routine clinical procedure. Recent surveys demonstrated that only 12% of german and 24% of french anesthesiologists use a nerve stimulator as a matter of routine. In hospitals nerve stimulators are not even available in half of the anesthesia working places.

Since residual neuromuscular blockade after general anesthesia is associated with increased perioperative morbitity, detection of prolonged neuromuscular block is of major clinical importance.

Mechanomyography is the gold standard for scientific measurements of neuromuscular function, but for clinical routine use mechanomyography is not reliable due to several drawbacks like being too time consuming to set up and being too sensible to inadvertant movements from the surgical team. Thus, methods based on electromyography or accelerometry have been developed for routine clinical monitoring of neuromuscular function. The practicability and accuracy of these methods have been compared with the standard mechanomyography with acceptable results. However, these neuromuscular function monitoring devices are additional machines limiting the working space of the anesthesiologist in the operating theatre. Therefore, a neuromuscular monitoring device based on mechanomyography, which is integrated in the compact monitor, would be a great improvement of the ergonometry of an anesthesia work place. This may result in an important improvement of patient saftey and the anesthesiologist´s satisfaction.

Recently a mechanomyographic sensor (MechanoSensor Datex-Ohmeda, Helsinki, Finland) has been developed with a monitoring device (M-NMT modul, Datex-Ohmeda, Helsinki, Finland), which is integrated into the anesthesia monitor (AS/3 Compact Monitor, Datex-Ohmeda, Helsinki, Finland). This mechanomyographic sensor and monitoring device has not yet been compared with standard neuromuscular function monitors. Therefore, we studied the accuracy of this monitoring device in comparison with standard accelometry and electromyography in patients undergoing major abdominal surgery.

Last updated: 1 June 2000
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