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. 2024 Apr-Jun;18(2):205-210.
doi: 10.4103/sja.sja_864_23. Epub 2024 Mar 14.

Tolerance to preoperative placement of electrodes for neuromuscular monitoring using the Tetragraph™

Leah M Espinal  1 , Sidhant Kalsotra  2 , Julie Rice-Weimer  2 , Sibelle A Yemele Kitio  2 , Joseph D Tobias  2   3
Affiliations

Tolerance to preoperative placement of electrodes for neuromuscular monitoring using the Tetragraph™

Leah M Espinal et al. Saudi J Anaesth. 2024 Apr-Jun.

Abstract

Background: Quantitative train-of-four (TOF) monitoring has recently been shown to be feasible in infants and children using a novel electromyography (EMG)-based monitor with a pediatric-sized self-adhesive sensor. However, placement of the sensor and initiation of TOF monitoring may require additional time in the operating room (OR), delaying workflow and the time to induction of anesthesia. The current study evaluates the feasibility of placing the self-adhesive sensor in the preoperative holding area in pediatric patients before arrival to the OR.

Methods: Consented pediatric patients undergoing inpatient surgery requiring the administration of NMBAs were enrolled. The EMG electrode was placed along the ulnar nerve on the volar aspect of the distal forearm to provide neurostimulation. After the induction of anesthesia, monitoring was initiated and TOF recording started before the administration of the NMBA. A Likert score (0-10) was used to assess ease of placement, tolerability of the monitor during the preoperative period, and its ability to generate a recorded response in the OR.

Results: The final study cohort included 40 patients with a median age of 3.7 years. Fourteen patients (35%) pulled off the sensor before arrival to the OR and 26 patients (65%) arrived at the OR with the sensor intact and functioning. Older children were more likely to maintain the sensor until arrival to the OR compared to younger patients (median age of 5.24 versus 1 year, P = 0.0521). A median age of 3.7 years correlated with an 80% chance of arriving in the OR with the sensor intact. Application ease and tolerance of the sensor were higher in the group that maintained the sensor until OR arrival.

Conclusion: In patients more than 4 years of age, placement of the self-adhesive sensor for EMG-based TOF monitoring may be feasible. However, in younger patients, additional interventions may be required to achieve a similar success rate.

Keywords: Neuromuscular blockade; neuromuscular blocking agents; train-of-four monitoring.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Photograph of the pediatric version of the TetraSens™ self-adhesive sensor for the Tetragraph™ EMG-based quantitative monitor
Figure 2
Figure 2
Pediatric recording electrodes (TetraSens™) attached to the palmar surface of the adductor pollicis muscle and its insertion on the medial aspect of the proximal phalanx of the thumb. The stimulating electrodes were placed along the ulnar nerve on the volar surface of the forearm
See this image and copyright information in PMC

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