Post-Operative Residual Curarization (PORC) incidence in post-anaesthesia care units (PACU) is estimated to be up to 45% after a single shot muscle relaxation1. Considering that about 230 millions of patients undergo a major surgery each year, about 100 patients per minute would suffer from discomfort, reduced ventilation capacity, double vision and a 4-to-5 times increased aspiration risk (see Fig X). Such residual effects have clinical consequences and complications that can prolong hospitalization, particularly in vulnerable population such as obese patients.
According to Prof. Jan Paul Mulier, AZ Sint Jan Hospital, Belgium, NMT monitoring is key to prevent respiratory complications in obese patients: listen to Prof. Jan Paul Mulier explaining why Neuromuscular Transmission monitoring is essential to optimize muscle relaxation in this challenging population.
Learn more by watching Prof Mulier’s full Symposium:
GE NMT monitoring technology
Electromyography (EMG) is the process of recording the specific electrical muscular fibers activity in response to ulnar nerve stimulation.
Kinemyography (KMG) uses a mechanoSensor and quantifies the evoked mechanical response by measuring the motion of the thumb by a piezoelectric sensor, which converts the physical motion to an electrical signal.
Adequate recovery from neuromuscular block, indicated by TOF>90%, can be reliably determined only with a quantitative measurement. EMG TOF ratio is an alternative gold standard, after Mechanomyography (MMG), for detecting neuromuscular block in clinical setting and is not interchangeable with Acceleromyography (ACG) TOF2.
Published literature suggests that quantitative measurement of neuromuscular transmission is the only recommended method to diagnose residual block1. Indeed, NMT measurements may help the clinician optimize dosage during anaesthesia1 and optimize recovery and prevention of respiratory complications in PACU.3,4,5,6
Learn more about AoA perioperative outcomes.
1. Debaene et al. Residual Paralysis in the PACU after a Single Intubating Dose of Nondepolarizing Muscle Relaxant with an Intermediate Duration of Action. Anesthesiology 2003; 98:1042–8
2.Liang et al. An ipsilateral comparison of acceleromyography and electromyography during recovery from nondepolarizing neuromuscular block under general anaesthesia in humans. Anesth Analgesia 2013 Aug; 117(2):373-9
3.Residual neuromuscolar block: lesson unlearned.Part II Methods to reduce the risk of residual weakness .Soriin Brull MD, Glenn Murphy MD. Anaesthesia-Analgesia July 2010 Volume 111 Number 1
4.Monitoring and Pharmacologic Reversal of a nondepolarizing neuromuscular blockade should be routine. Ronald Miller MD, Theresa Ward BSN, RN . Anaesthesia-Analgesia July 2010 Volume 111 Number 1.
5.Evidence –Based management of neuromuscular block. Mogensen MD DMSc FRCA, Casper Claudio MD PhD. Anaesthesia-Analgesia July 2010 Volume 111 Number 1.
6. Neuromuscular Monitoring: what evidence do we need to be convinced? Donati, PhD, MD. Anestehsia-Analgesia July 2010 Volume 111 Number 1.
Download Recommendations for appropriate use of GE NMT monitoring equipment, NMT reference article list and NMT quick guide.