Genel anestezinin ekstübasyon aşamasında Hasta Durumu İndeksi monitörü ile ölçülen Frontal EMG ile Train Of Four'un korelasyonu

Year 2023, Volume: 56 Issue: 3, 173 - 177, 21.01.2024

Hakan Gökalp Taş , Didem Onk , Ufuk Kuyrukluyıldız , Süheyla Ünver

https://doi.org/10.20492/aeahtd.1378686

Abstract

Amaç: Genel anestezi altındaki hastalar için işlenmiş elektroensefalografi (EEG) monitörizasyonu (örneğin, Hasta Durum İndeksi-PSI) ve "train of four" (TOF) monitörlerinin rutin kullanımı önerilmektedir. Çalışmamızın amacı, PSI monitörü ile kas gücünü değerlendirebilen frontal elektromiyografi (EMG) parametresinin, ölçülen TOF değeri ile olan ilişkisini incelemek, böylece hem kas gücünün hem de anestezi derinliğinin tek bir monitörizasyon tekniği ile değerlendirilebilmesidir.
Gereç ve Yöntem: Çalışmamıza 18-65 yaş arasındaki, American Society of Anesthesiologists (ASA) risk skoru I-III olan ve 1 saatten uzun süren genel anestezi uygulanan 100 hasta dahil edildi. İşlem sona erdikten sonra, PSI ve EMG değerleri TOF'un %0, %25, %50, %75 ve %90 zaman noktalarında kaydedildi. TOF %90 olduğunda hastalar ekstübe edildi. TOF, PSI ve EMG için son ölçümler ekstübasyondan 5 dakika sonra kaydedildi.
Bulgular: TOF ile PSI (r=0.74, p<0.001) ve TOF ile EMG (r=0.76, p<0.001) arasında güçlü bir pozitif ilişki bulundu. TOF ve EMG ile PSI değişkenleri için ROC analizi uygulandığında, EMG için ekstübasyon kesim noktası 24.5 (Eğri Altındaki Alan (AUC):0.852, p<0.001) iken PSI için 60.5 (AUC:0.834, p<0.001) olarak bulundu ve her ikisi de istatistiksel olarak anlamlıydı.
Sonuç: TOF ve frontal EMG değerleri arasında güçlü bir pozitif ilişki tespit edilmiştir. ROC analizinin sonucu olarak, çalışmamız, ekstübasyon kararı verilirken frontal EMG değerinin 24.5'in üzerinde veya PSI değerinin 60'ın üzerinde olmasının destekleyici olduğunu göstermektedir.

Anahtar Kelimeler: Akselerometre; Anestezi, Genel; Anestezi Derlenme Dönemi; Elektromiyografi; Nöromusküler Monitörizasyon

Keywords

Akselerometre, Genel Anestezi, Anestezi Derlenme Dönemi, Elektromiyografi, Nöromusküler Monitörizasyon

Ethical Statement

Çalışmaya ERZİNCAN BİNALİ YILDIRIM ÜNİVERSİTESİ Klinik Araştırmalar Etik Kurulu onayı ( 27/11/2018 tarih ve 34/11 sayılı kararı) alındıktan sonra başlanmıştır

Supporting Institution

Yok

Thanks

Mengücek Gazi Eğitim ve Araştırma Hastanesi Anesteziyoloji ve Reanimasyon Anabilim Dalı'nda görevli tüm çalışan personele teşekkür ederiz

Correlation of Train Of Four with Frontal EMG measured by Patient State Index monitor in extubation phase of general anesthesia

Abstract

Aim: The routine use of processed electroencephalography (EEG) monitoring (like Patient State Index-PSI) and train of four (TOF) monitors is recommended for patients under general anesthesia. The aim of our study is to examine the correlation of the frontal electromyography (EMG) parameter, which can evaluate muscle strength in PSI monitoring, with the measured TOF value, so that both muscle strength and anesthetic depth can be evaluated with a single monitoring technique.
Materials and methods: One hundred patients aged 18-65 years old, American Society of Anesthesiologists risk score (ASA) I-III who underwent general anesthesia that lasted more than 1 hour were included in our study. Following the end of the procedure, PSI and EMG values were recorded at TOF of 0%, 25%, 50%, 75% and 90% time points. When TOF was 90%, patients were extubated. Final measurements for TOF, PSI and EMG were recorded 5 minutes after extubation.
Results: A strong positive relationship was found both between TOF and PSI (r=0.74 p<0.001), and between TOF and EMG (r=0.76 p<0.001). When receiver operating characteristic (ROC) analysis was applied to TOF and EMG and PSI variables, the extubation cut-off point for EMG was 24.5 (Area Under the Curve (AUC):0.852, p<0.001) while PSI showed 60.5 (AUC:0.834, p<0.001) which were both statistically significant.
Conclusions: Results demonstrate a strong positive correlation between TOF and frontal EMG values. As a result of the ROC analysis, our study suggests that a frontal EMG value above 24.5 or a PSI value above 60 is supportive when making the extubation decision.

Key Words: Accelerometry; Anesthesia, General; Anesthesia Recovery Period; Electromyography; Neuromuscular Monitoring

Keywords

Accelerometry, General Anesthesia, Anesthesia Recovery Period, Electromyography, Neuromuscular Monitoring

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