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

Yıl 2023, Cilt: 56 Sayı: 3, 173 - 177, 21.01.2024

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

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

Öz

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

Anahtar Kelimeler

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

Etik Beyan

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

Destekleyen Kurum

Yok

Teşekkür

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

Öz

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

Anahtar Kelimeler

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

Kaynakça

• 1.Drover D, Ortega HR. Patient state index. Best Pract Res Clin Anaesthesiol. 2006;20(1):121-8. doi:10.1016/j.bpa.2005.07.008
• 2.Myles PS, Leslie K, McNeil J, Forbes A, Chan M, Group B-AT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363(9423):1757- 63. doi:10.1016/S0140-6736(04)16300-9
• 3.Auroy Y, Benhamou D, Péquignot F, Bovet M, Jougla E, Lienhart A. Mortality related to anaesthesia in France: analysis of deaths related to airway complications. Anaesthesia. 2009;64(4):366-70. doi:10.1111/j.1365-2044.2008.05792.x
• 4.Cook T, Scott S, Mihai R. Litigation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia. 2010;65(6):556-63. doi:10.1111/j.1365-2044.2010.06331.x
• 5.Jubb A, Ford P. Extubation after anaesthesia: A systematic review. Update Anaesth. 06/01 2009;25:30-6.
• 6.Brull SJ, Kopman AFJA. Current status of neuromuscular reversal and monitoring: challenges and opportunities. Anesthesiology. 2017;126(1):173-90. doi:10.1097/ALN.0000000000001409
• 7. Naguib M, Brull SJ, Kopman AF, et al. Consensus Statement on Perioperative Use of Neuromuscular Monitoring. Anesth Analg. 2018;127(1):71-80. doi:10.1213/ane.0000000000002670
• 8.Jones JH, Nittur VR, Fleming N, Applegate RL, 2nd. Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial. BMC Anesthesiol. 2021;21(1):105. doi:10.1186/s12871-021- 01326-5
• 9.Idei M, Seino Y, Sato N, et al. Validation of the patient State Index for monitoring sedation state in critically ill patients: a prospective observational study. J Clin Monit Comput. 2023;37(1):147-54. doi:10.1007/ s10877-022-00871-9
• 10.Checketts M, Alladi R, Ferguson K, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):85-93. doi:10.1111/anae.13316
• 11.Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller’s anesthesia e-book. Elsevier Health Sciences; 177 2014.
• 12.Claudius C, Viby-Mogensen J, Warner DS, Warner MA. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence. Anesthesiology. 2008;108(6):1117-40. doi:10.1097/ALN.0b013e318173f62f
• 13.Churchill-Davidson H, Christie T. The diagnosis of neuromuscular block in man. Br J Anaesth. 1959;31(7):290-301. doi:10.1093/ bja/31.7.290.
• 14.Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110-9.
• 15.Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg. 2010;111(1):129-140. doi:10.1213/ANE.0b013e- 3181da8312.
• 16.Debaene B, Plaud B, Dilly M-P, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98(5):1042-8. doi:10.1097/00000542-200305000-00004.
• 17.Williams MT, Rice I, Ewen S, Elliott S. A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy. Anaesthesia. 2003;58(6):574-8. doi:10.1046/ j.1365-2044.2003.03150.x.
• 18.King M, Sujirattanawimol N, Danielson DR, Hall BA, Schroeder DR, Warner DO. Requirements for muscle relaxants during radical retropubic prostatectomy. Anaesthesia. 2000;93(6):1392-7. doi:10.1097/00000542-200012000-00008.
• 19.Caputo TD, Ramsay MA, Rossmann JA, et al. Evaluation of the SEDline to improve the safety and efficiency of conscious sedation. Bayl Univ Med Cent. 2011;24(3):200-4. doi:10.1080/08998280.201 1.11928715.
• 20.Demirel I, Yildiz Altun A, Bolat E, et al. Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia. J Perianesth Nurs. 2021;36(1):69-74. doi:10.1016/j.jopan. 2020.07.005
• 21.Buget MI, Atalar AC, Edipoglu IS, et al. Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position. Braz J Anesthesiol. 2016;66(5):470-4. doi:10.1016/j. bjane.2015.02.002
• 22.Aytac I, Postaci A, Aytac B, et al. Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists. Braz J Anesthesiol. 2016;66(1):55-62. doi:10.1016/j. bjane.2012.06.011
• 23.Bissinger U, Schimek F, Lenz G. Postoperative residual paralysis and respiratory status: a comparative study of pancuronium and vecuronium. Physiol Res. 2000;49(4):455-62.
• 24.Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107(1):130-137. doi:10.1213/ane.0b013e31816d1268.