Quantitative Train-of-Four Monitoring and the Assessment of Train-of Four Count

<b>Background</b>: Many surgical procedures require muscle paralysis of the patient to ensure optimum operating conditions. Monitoring the level of paralysis is an important responsibility of the nurse anesthetist throughout the entire procedure. At the conclusion of the procedure, the paralysis is reversed with reversal medications, the doses of which are determined by the level of muscle response to an electronic stimulus. The most frequently used method of assessing this response is a subjective method requiring the nurse anesthetist to visualize and/or feel the muscle movement and base their reversal dose off this interpretation. This method is known as peripheral nerve stimulation (PNS). If, in fact, the strength of the results is misinterpreted, the patient may be underdosed with reversal agent and suffer residual neuromuscular blockade symptoms (RNMB) in the Post Anesthesia Care Unit (PACU). Newer technologies have evolved to provide the nurse anesthetist with a quantitative approach to assessing the return of muscle strength, clinically referred to as the Train-of-Four Ratio (TOFR). This technique removes subjectivity, provides objectivity, and has been shown to decrease RNMB symptoms in recovering patients. <b>Purpose</b>: The purpose of this project was to assess whether the use of subjective PNS accurately correlates with the data provided by the objective quantitative data from electromyographic neuromuscular monitoring (EMG). A second aim was to assess whether quantitative neuromuscular monitoring use aids in decreasing RNMB symptoms in PACU. <b>Methods</b>: This project utilized a quality improvement design. Quantitative data was collected on surgical patients undergoing muscle paralysis. Numerical data from the EMG device was then compared to the clinician’s PNS rating at the time of reversal of paralysis. A second EMG reading was taken immediately after the patient was extubated to assess the TOFR value. Data was analyzed using descriptive statistics to assess the validity of the data as well as statistical significance. <b>Implementation Plan/Procedure</b>: The project took place at Putnam County Hospital. Fifteen surgical patients requiring muscle paralysis were monitored with EMG monitoring and PNS monitoring. EMG data was be hidden from the anesthesia provider during the project.

Creator

• Meyer, Clifton

Language

• English

Keyword

• Quantitative neuromuscular monitoring
• residual neuromuscular blockade
• qualitative neuromuscular monitoring
• peripheral nerve stimulator
• electromyography
• neuromuscular blockade reversal

Date created

• 2023

Resource type

• Research Paper

Rights statement

• http://rightsstatements.org/vocab/InC/1.0/