Neuromuscular monitoring is a technique used in anesthesia to quantitatively determine the functionality of a person’s muscles. It is used during a patient’s recovery from the application of general anesthesia. There are several clinical tests that an anaesthetist can use to assess muscle function and power. In the past, crude means, such as testing a patient’s ability to sustain a head lift for five seconds, were used. The advancement of technology has led to better methods that are more comfortable for the patient, and also more accurate, especially for lower TOF ratios. TOF monitoring is commonly used today.
A train-of-four (TOF) ratio monitor, also known as a peripheral nerve stimulator is a device that is used to determine the degree of neuromuscular block. This monitor functions by applying a supramaximal stimulus to a nerve and then it measures the muscular response to the change. To work best, a peripheral nerve stimulator is used on nerves that must meet certain criteria. The nerve must:
- contain a motor element
- be located close to the surface (skin)
- be controlling a muscle or muscle group whose movement can be observed.
An electrical current is applied using ECG electrodes. The effect of the current is maximal muscle contraction. The TOF ratio monitor then computes the ratio based on the resulting contraction.
A peripheral nerve stimulator is used by anaesthetists after an operation on a patient. In some cases, a neuromuscular block may persist after anesthesia. This condition is commonly referred to as residual paralysis, and its extent varies from patient to patient. Although seemingly mild, residual paralysis has been linked to oxygen desaturation, pulmonary collapse, muscle weakness, and acute respiratory failure that could be fatal. Different parts of the body recover at different rates, and so a reliable method of measuring the recovery is required. Residual paralysis quite common and a recent study has shown that 45% of patients experienced it. It is important for anaesthetists to quickly and accurately determine the presence of residual paralysis. This helps to prevent further complications that may result from late detection. This led to the invention of these gadgets, and since then, they have increased tremendously in popularity. There are now several peripheral nerve stimulator manufacturers in the market who are helping to lower the cost of these devices and thus make them more available to the majority. PNS devices are making the work easier for the anaesthetists and helping to save lives.
There are several benefits of using a TOF monitor. Using tactile (visual) methods to determine the muscular response is subjective and hence it is not reliable. It has been proven that even the most experienced anaesthetists cannot measure low TOF ratios. Clinical measurements alone could, therefore, be unable to detect minimal levels of paralysis. Such minimal errors could be quite costly for the patient as the problem could deteriorate and cause complications. TOF monitors are a great invention and they have helped to prevent many complications.
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