Counting train-of-four twitch response: comparison of palpation to mechanomyography, acceleromyography, and electromyography. (June 2020)

• Record Type: Journal Article
• Authors: Bowdle, Andrew; Bussey, Logan; Michaelsen, Kelly; Jelacic, Srdjan; Nair, Bala; Togashi, Kei; Hulvershorn, Justin
• Is Part Of: British journal of anaesthesia. Volume 124:Number 6(2020)
• Page Start: 712
• Page End: 717
• Publication Date: 2020-06
• Subjects: acceleromyography -- electromyography -- mechanomyography -- monitor -- neuromuscular blocking agent -- reversal; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2020.02.022
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: Train-of-four twitch monitoring can be performed using palpation of thumb movement, or by the use of a more objective quantitative monitor, such as mechanomyography, acceleromyography, or electromyography. The relative performance of palpation and quantitative monitoring for determination of the train-of-four ratio has been studied extensively, but the relative performance of palpation and quantitative monitors for counting train-of-four twitch responses has not been completely described. Methods: We compared train-of-four counts by palpation to mechanomyography, acceleromyography (Stimpod™), and electromyography (TwitchView Monitor™) in anaesthetised patients using 1691 pairs of measurements obtained from 46 subjects. Results: There was substantial agreement between palpation and electromyography (kappa = 0.80), mechanomyography (kappa = 0.67), or acceleromyography (kappa = 0.63). Electromyography with TwitchView and mechanomyography most closely resembled palpation, whereas acceleromyography with StimPod often underestimated train-of-four count. With palpation as the comparator, acceleromyography was more likely to measure a lower train-of-four count, with 36% of counts less than palpation, and 3% more than palpation. For mechanomyography, 31% of train-of-four counts were greater than palpation, and 9% were less. For electromyography, 15% of train-of-four counts were greater than palpation, and 12% were less. The agreement between acceleromyography and electromyography was fair (kappa = 0.38). For acceleromyography, 39% of train-of-four counts were less than electromyography, and 5% were more. Conclusions: Acceleromyography with the StimPod frequently underestimated train-of-four count in comparison with electromyography with TwitchView.