Evaluation of a three-axial acceleromyography monitor in dogs compared with mechanomyography

Chia T Tseng; Daniel M Sakai; Augusto M Lorenzutti; Manuel Martin-Flores

doi:10.1016/j.vaa.2023.06.002

Evaluation of a three-axial acceleromyography monitor in dogs compared with mechanomyography

Vet Anaesth Analg. 2023 Sep;50(5):408-414. doi: 10.1016/j.vaa.2023.06.002. Epub 2023 Jun 13.

Authors

Chia T Tseng¹, Daniel M Sakai², Augusto M Lorenzutti³, Manuel Martin-Flores⁴

Affiliations

¹ Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA; Crown Veterinary Specialists, Lebanon, NJ, USA.
² Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA; Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA. Electronic address: dmsakai@uga.edu.
³ Facultad de Ciencias Agropecuarias, IRNASUS CONICET, Universidad Catolica de Cordoba, Cordoba, Argentina.
⁴ Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.

PMID: 37500406
DOI: 10.1016/j.vaa.2023.06.002

Abstract

Objective: To compare the ratio of the train-of-four (TOF) and double burst stimulation (DBS) obtained with three-axial acceleromyography (AMG) and mechanomyography (MMG) in dogs during recovery from a rocuronium-induced neuromuscular block.

Study design: Prospective, randomized, experimental study.

Animals: A total of six intact healthy adult male Beagle dogs, weighing 9.1 ± 1.9 kg and aged 3-5 years.

Methods: Dogs were anesthetized with intravenous (IV) dexmedetomidine and propofol, and isoflurane in oxygen. Neuromuscular function was measured with AMG and MMG in the contralateral thoracic limbs. Rocuronium (0.5 mg kg^-1) was administered IV, and the TOF and DBS ratios measured. During neuromuscular block offset, MMG values were recorded when AMG first reached ratios of 0.9 and 1.0. True recovery from neuromuscular block was determined as MMG ratio ≥ 0.9. The false-positive (AMG ≥ 0.9 or 1.0, and MMG ratio < 0.9) rate was determined. Paired values were compared, and bias and limits of agreement were calculated. Receiver operating characteristic (ROC) curves were created.

Results: When AMG first reached 0.9 and 1.0 during recovery, MMG values were lower (p < 0.040). When AMG reached 0.9, the false-positive rate was 29% with TOF and 27% with DBS. It decreased to 12% (TOF) and 11% (DBS) when a ratio of 1.0 was used. AMG values were higher than paired MMG values (p < 0.001). The AMG overestimated MMG by 24% and 22% for TOF and DBS, respectively. Areas under the ROC curves (95% confidence interval) were 0.91 (0.89, 0.94) and 0.86 (0.81, 0.94) for TOF and DBS, respectively.

Conclusions: and clinical relevance The three-axial AMG monitor overestimated neuromuscular function and, in some cases, indicated adequate recovery despite the MMG ratio being < 0.9. A TOF or DBS ratio of at least 1.0 should be considered when monitoring recovery of neuromuscular block with this AMG device.

Keywords: Stimpod; anesthesia safety; aspiration pneumonia; canine; neuromuscular blockade; residual neuromuscular block.

Publication types

Randomized Controlled Trial, Veterinary

MeSH terms

Animals
Dogs
Male
Muscle Contraction / physiology
Neuromuscular Blockade* / veterinary
Prospective Studies
Rocuronium

Substances

Rocuronium