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. 2020 Feb;34(1):79-85.
doi: 10.1007/s00540-019-02712-7. Epub 2019 Nov 23.

Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries

Alexander Dullenkopf  1 , Katja Horn  2 , Marc P Steurer  3 , Florian Hess  4 , JoEllen Welter  2
Affiliations

Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries

Alexander Dullenkopf et al. J Anesth. 2020 Feb.

Abstract

The aim of this study was to compare two devices for neuromuscular monitoring during anesthetic induction. TOF-Cuff® was installed on the lower leg stimulating the tibial nerve, while the more conventional TOF-Scan® was installed over the ulnar nerve at the wrist. Methods Twenty adult patients were enrolled in this prospective, controlled study. Train-of-four (TOF) was recorded every 15 s until TOF ratio of 0%. Mean arterial blood pressure (MAP) was assessed with TOF-Cuff® and with standard anesthesia monitoring from the brachial artery. MAP was measured before and after anesthetic induction. Time to TOF ratio = 0% was compared with one-sample t test and Bland-Altman plots. Results Patients received 0.53 ± 0.09 mg atracurium per kg body weight intravenously. Mean time to TOF ratio = 0% was 150.8 s (± 43.7) for TOF-Scan®, and 174.4 s (± 42.7) for TOF-Cuff® (p = 0.1356). Bias was - 15.9 (95% confidence interval - 37.5 to 5.6) with 95% limits of agreement of - 95.2 to 63.3. Twenty-five percent of the patients had a technical issue with a TOF-Cuff® measurement. For MAP, mean difference was 1.4 (95% confidence interval - 2.4 to 5.2) with 95% limits of agreement of - 22.7 to 25.5. Conclusion The time from administration of a common dose of atracurium to a TOF ratio of 0% assessed with TOF-Cuff® stimulating the tibial nerve compared to TOF-Scan® stimulating the ulnar nerve showed large limits of agreement in Bland-Altman analysis. There was a high failure rate with TOF-Cuff® measurements on the lower leg.

Keywords: Accelerometry; Neuromuscular monitoring; Neuromuscular transmission.

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Figures

Fig. 1
Fig. 1
Bland–Altman plot for time to TOF ratio = 0%. The solid line illustrates the mean difference and the dashed lines indicate average difference ± 1.96 standard deviation of the difference
Fig. 2
Fig. 2
Relaxation over time for each patient for TOF-Scan® and TOF-Cuff®
Fig. 3
Fig. 3
Bland–Altman plot for mean arterial (MAP) blood pressure. The solid line illustrates the weighted mean difference and the dashed lines indicate average difference ± 1.96 weighted standard deviation of the difference
See this image and copyright information in PMC

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