Neuromuscular monitoring in clinical practice and research : Mit elnem Geleitwort von Robert Jütte

Neuromuscular monitoring is critical for the judicious use of muscle relaxants. In combination with reversal, it is fundamental to every successful strategy for managing postoperative residual blocks. This reference work is a compendium of all the essential information needed to monitor neuromuscular function. Physiological and pharmacological basics of neuromuscular transmission, principles of neuromuscular monitoring: How to place stimulation electrodes, properly select the stimulation mode and interprete findings, practical techniques for clinical routine, clinical concepts behind qualitative and quantitative nerve stimulators, comprehensive presentation of acceleromyography including a question & answer section, summaries of all key points, current guidelines on the scientific use of acceleromyography. Neuromuscular Monitoring in Clinical Practice and Research......Page 1 Front-matter......Page 2 Title Page ......Page 4 Copyright Page ......Page 5 Foreword......Page 6 Preface......Page 8 Table of Contents......Page 10 List of abbreviations......Page 14 1 Principles of neuromuscular transmission......Page 16 Neuromuscular endplate......Page 17 1.1.2 Action potential......Page 19 Storage and release......Page 20 Structure......Page 22 Activation......Page 23 1.1.5 Presynaptic nicotinic acetylcholine receptors......Page 24 Electromechanical coupling......Page 25 Mechanism of action......Page 26 Features of non-depolarizing blockades......Page 27 Safety margin......Page 28 Sequence of neuromuscular blockade......Page 29 Features of depolarization blockades......Page 30 Mechanism of action......Page 31 Indirectaction......Page 32 Representative compounds......Page 33 Mechanism of action......Page 34 References......Page 37 2 Principles of neuromuscular monitoring......Page 38 Supramaximal current......Page 39 2.2 Stimulation electrodes......Page 41 Direct muscle stimulation......Page 43 2.3 Stimulation site/test muscle......Page 45 2.3.1 Ulnar nerve/adductorpollicis muscle......Page 46 2.3.2 Posterior tibial nervelflexor hallucis brevis muscle......Page 47 2.3.3 Facial nerve/orbicularis occuli muscle or facial nerve/corrugator supercilii muscle......Page 48 2.4 Anesthesia-relevant muscle groups......Page 52 2.4.1 Diaphragm......Page 53 2.4.3 Abdominal muscles......Page 54 2.4.5 Pharyngeal muscles......Page 55 2.5 Stimulation patterns......Page 56 2.5.1 Single twitch......Page 57 2.5.2 Train-of-four......Page 58 2.5.3 Double-burst stimulation......Page 64 2.5.4 Tetanic stimulation......Page 66 2.5.5 Post-tetanic count......Page 68 2.6.1 Simple nerve stimulators......Page 71 2.6.2 Quantitative nerve stimulators......Page 74 Mechanomyography......Page 75 Electromyography......Page 76 Acceleromyography......Page 78 Phonomyography......Page 81 Kinemyography......Page 83 References......Page 85 3 Clinical application......Page 88 3.1 Neuromuscular monitoring during anesthesia induction......Page 91 3.1.1 Neuromuscular blocking agents for anesthesia induction?......Page 92 Test muscles......Page 97 Stimulation patterns......Page 100 3.1.3 What level of neuromuscular block for intubation?......Page 102 3.2 Intraoperative application of neuromuscular monitoring......Page 105 3.2.1 Accumulation of NMBAs......Page 106 3.2.2 Stimulation patterns and test muscles......Page 110 Complete neuromuscular recovery?......Page 112 Pulmonary muscles......Page 113 Respiratory control......Page 114 Safety margin......Page 116 Patient comfort......Page 117 Minimal residual neuromuscular blockade......Page 119 Upper airway function during adequate neuromuscular recovery......Page 120 3.3.2 Frequency of residual neuromuscular blockade......Page 121 3.3.3 Clinical implications associated with residual neuromuscular blockade......Page 123 Paradoxical respiration or jerky, uncontrolled movements of the extremities......Page 125 Tongue depressor test......Page 126 Stimulation patterns......Page 127 Testmuscles......Page 128 3.3.5 Prevention strategies for residual neuromuscular blockade......Page 129 Qualitative neuromuscular monitoring......Page 130 Quantitative neuromuscular monitoring......Page 132 References......Page 135 4 Acceleromyography......Page 139 4.1 Principles......Page 141 4.2 The Accelograph and the TOF-Guard......Page 142 4.3.1 The TOF ratio algorithm......Page 145 4.3.2 Calibration modes......Page 148 4.3.3 Nerve localization in regional anesthesia procedures......Page 151 4.4.1 Short set-up instructions......Page 153 4.4.2 Brief overview......Page 154 4.4.3 Scheme of buttons and display symbols......Page 155 Alarms......Page 162 Settings......Page 164 4.5.1 Short set-up instructions......Page 165 4.5.2 Brief overview......Page 166 4.5.3 Scheme of buttons and display symbols......Page 167 Starting up the TOF-Watch® S......Page 169 Selecting the stimulation mode......Page 171 Alarms......Page 174 Settings......Page 176 4.6.1 Short set-up instructions......Page 179 4.6.2 Brief overview......Page 180 4.6 .3 Scheme of buttons and display symbols......Page 181 Starting up the TOF-Watch® SX......Page 183 Selecting the stimulation mode......Page 185 Alarms......Page 189 Settings......Page 191 4.7.1 Canacceleromyography alsobe usedin infants?......Page 194 4.7.2 Isneuromuscular monitoring painful for patients?......Page 195 4.7.3 What to observe when attaching TOF-Watch® nerve stimulators?......Page 197 4.7.4 Is calibration really necessary?......Page 199 4.7.5 Can neuromuscular monitoring with the TOF-Watch® nerve stimulator prevent residual blockade?......Page 205 4.8 Acceleromyography in research......Page 208 Stimulation patterns......Page 209 Calibration......Page 210 Intubation conditions......Page 211 Choice of materials......Page 212 4.8.3 Guidelines for measuring onset and time profile of neuromuscular blockade......Page 213 Onset of action/onset time......Page 214 Concluding remarks......Page 215 References......Page 217 Subject Index......Page 220