Kinemyography (KMG) versus Electromyography (EMG) neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia

Gaffar, Emad A.; Fattah, Salah A.; Atef, Hossam M.; Omera, Magdy A.; Abdel-Aziz, Mohammed A.

doi:10.1016/j.egja.2013.02.006

Kinemyography (KMG) versus Electromyography (EMG) neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia

Authors

10.1016/j.egja.2013.02.006

Abstract

Aim of the work
To compare KMG versus EMG neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia.
Methods
After approval of the protocol by Ethics Committee 24 pediatric patients of both sexes aged 2–6 years, with a maximum weight 20 kg, were included in the study. Monitoring equipments (Datex-Ohmeda A/S 5™) were attached to the patient. The electromyogram was attached to one hand, while, KMG was attached to the other hand for simultaneous monitoring. Induction of anesthesia with fentanyl 2 μg/kg and propofol 2 mg/kg followed by endotracheal intubation. Anesthesia was maintained by end-tidal isoflurane 1.2%. Ventilation was kept by 50% oxygen in air and was adjusted to maintain end-tidal CO in the range of 35–40 mm Hg. After a stable baseline period of at least 3 min, the 24 patients were received 0.1 mg/kg cisatracurium twice the 95% effective dose (2 × ED). The following parameters were collected and compared; (1) lag time (time from start of muscle relaxant administration until the first measurable neuromuscular block (NMB), (2) onset time (time from start of muscle relaxant administration until maximal NMB), (3) assessing the recovery period by; train of four (TOF) 0.25, 0.50, 0.75 and 0.90 (time to reach a TOF ratio of 25%, 50%, 75% and 90%, respectively). No top-up doses of muscle relaxants were given.
Results
There was no statistical difference between both studied groups as regard the demographic data of the patients, the lag time, the onset time, TOF 0.25, 0.5, 0.75 and 0.9 ratios using either EMG or KMG. In addition, there is excellent degree of agreement between EMG and KMG in measuring TOF ratio during both induction and recovery of muscle relaxants.
Conclusions
KMG showed an excellent degree of agreement with EMG for determination of onset and recovery of NMB in children.

Keywords