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Visual Representation of TOF Monitoring to Evaluate Reversal Potential
Visual Representation of TOF Monitoring to Evaluate Reversal Potential
Submitted on 19 Apr 2018

Kyle Twiss, B.S., sAA and Brienne Seekford, B.S., SAA
Quinnipiac University
This poster was presented at American Academy of Anesthesiologist Assistants 2018 Annual Meeting & Career Expo
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Poster Abstract
Objective neuromuscular monitoring systems are rarely used (only in 17% of patients) in the perioperative management of patients who have received non-depolarizing muscle relaxants (NDMR) [1]. Subjective neuromuscular monitoring methods, used in less than 40% of patients receiving NDMR, include visual and tactile assessments like a 5-second head lift, grip strength, leg lift tests and measurement of respiratory parameters like tidal volume, minute ventilation, vital capacity and others [1]. All of these subjective tests are commonly correlated with neuromuscular recovery but they are ultimately unreliable and nonspecific. In reality, none of these subjective clinical tests have a sensitivity greater than 0.35 or a positive predictor value greater than 0.52 [1]. This leads to 20-40% of patients arriving to the PACU with effects of residual neuromuscular blockade that can lead to hypoxemic episodes, airway obstruction, postop respiratory complications, muscle weakness and intraoperative awareness [1]. Using an Arduino and a 16x16 LED display, the monitor we created shows four separate columns, each representing one of the four twitches in the train of four. The maximum height of each column is ten LED’s high so by comparing the height of the T1 to T4, an anesthesia provider can objectively assess whether a patient can be safely extubated without risk of neuromuscular blockade. The sample size for our data collection was five people (two S-AA’s, two C-AA’s, and an anesthesiologist) and they all responded to the ten patterns with 100 percent accuracy. Knowing that our current model can be interpreted correctly, the next step would be to make improvements to make it even easier to understand and marrying the display to a nerve stimulator with an accelerometer. Our primary goal was to create a monitor that could provide indication of T1:T4 ratio to allow for safe extubation, but we feel the monitor we have constructed displays information that can be used in a variety of clinical scenarios.

[1] Sorin J. Brull, M.D., F.C.A.R.C.S.I. (Hon), Aaron F. Kopman, M.D. “Current Status of Neuromuscular Reversal and Monitoring.” Anesthesiology, vol. 126, no. 1, 2017, pp. 173-90.

[2] Longnecker DE, Brown DL, Newman MF, Zapol WM. eds. Anesthesiology, 2e, New York, NY: McGraw-Hill; 2012.

[3] Jeffrey L. Apfelbaum, , Jeffrey H. Silverstein, et al. “Practice Guidelines for Postanesthetic Care: An Updated Report by the American Society of Anesthesiologists Task Force on Postanesthetic Care.” Anesthesiology, 2013;118(2):291-307.
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