Ipsilateral and Simultaneous Comparison of Responses from Acceleromyography- and Electromyography-based Neuromuscular Monitors

Background The paucity of easy-to-use, reliable objective neuromuscular monitors is an obstacle to universal adoption routine monitoring. Electromyography (EMG) has been proposed as the optimal monitoring technology since it addresses several acceleromyography limitations. This clinical study compared simultaneous responses recorded from induction block until recovery using acceleromyography-based TOF-Watch SX and EMG-based TetraGraph. Methods Fifty consenting patients participated. EMG devices analyzed contractions (acceleromyography) muscle action potentials adductor pollicis by synchronization via fiber optic cable link. Bland–Altman analysis described agreement between during distinct phases block. primary endpoint was acceleromyography- EMG-derived normalized train-of-four ratios greater than or equal 80%. Secondary endpoints were in ratio range less 80% baseline devices. Results Acceleromyography showed earlier EMG. When (n = 2,929), bias 1.3 toward (limits agreement, –14.0 16.6). 2,284), –0.5 (–14.7 13.6). In 2,802), 2.1 (–16.1 20.2), 3,447), 2.6 (–14.4 19.6). Baseline higher more variable with Conclusions Bias lower previous studies. Limits wider expected because readings varied both at recovery. monitor had precision repeatability acceleromyography. difference even when data raw (nonnormalized) measurements. a better indicator adequate readiness for safe tracheal extubation monitor. Editor’s Perspective What We Already Know about Topic Article Tells Us That Is New