Comparison of the TOFscan and the TOF-Watch SX during recovery of neuromuscular function

Glenn S. Murphy*, Joseph W. Szokol, Michael J. Avram, Steven B. Greenberg, Torin D. Shear, Mark Deshur, Jessica Benson, Rebecca L. Newmark, Colleen E. Maher

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyography device that measures movement of the thumb in multiple planes. The aim of this observational investigation was to assess the agreement between nonnormalized and normalized train-of-four values obtained with the TOF-Watch SX (Organon, Ireland) and those obtained with the TOFscan during recovery from neuromuscular blockade. Methods: Twenty-five patients were administered rocuronium, and spontaneous recovery of neuromuscular blockade was allowed to occur. The TOFscan and TOF-Watch SX devices were applied to opposite arms. A preload was applied to the TOFWatch SX, and calibration was performed before rocuronium administration. Both devices were activated, and train-of-four values were obtained every 15 s. Modified Bland-Altman analyses were conducted to compare train-of-four ratios measured with the TOFscan to those measured with the TOF-Watch SX (when train-of-four thresholds of 0.2 to 1.0 were achieved). Results: Bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at nonnormalized train-of-four ratios between 0.2 and 1.0 were 0.021 and -0.100 to 0.141, respectively. When train-of-four measures with the TOF-Watch SX were normalized, bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at ratios between 0.2 and 1.0 were 0.015 and -0.097 to 0.126, respectively. Conclusions: Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery.

Original languageEnglish (US)
Pages (from-to)880-888
Number of pages9
JournalAnesthesiology
Volume129
Issue number5
DOIs
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Murphy, G. S., Szokol, J. W., Avram, M. J., Greenberg, S. B., Shear, T. D., Deshur, M., Benson, J., Newmark, R. L., & Maher, C. E. (2018). Comparison of the TOFscan and the TOF-Watch SX during recovery of neuromuscular function. Anesthesiology, 129(5), 880-888. https://doi.org/10.1097/ALN.0000000000002400