Absence of intraoperative specific monitoring increases the incidence of post-operative complications for patients receiving neuromuscular blockade
Recently, a new observational, prospective, multicenter study published by Errando et al. showed that the current practice of monitoring neuromuscular function in patients receiving neuromuscular blocking agents is inadequate – this calls for a new and standardized method of intraoperative monitoring.
It is well documented that, in the post-anesthesia care unit, patients with residual neuromuscular blockade are subject to increased incidence of severe complications such as critical respiratory events and need for tracheal reintubation. The TetraGraph System is a new generation of EMG-based devices that can aid clinicians in making decisions regarding the adequacy of neuromuscular function in real-time. This study clearly demonstrates the clinical need for the TetraGraph.
For the past 30 years, multiple studies have reported an incidence of residual block of 25-50% in patients who were assessed intraoperatively either subjectively or guided by clinical signs. Gender, duration of surgery, type of relaxant and reversal drugs used, amongst other factors, is significantly associated with residual blockade. Residual blockade is defined as a train-of-four ratio (TOFr) less than 90% (0.90), where normal function is defined as a TOFr of 100% (1.0).
The authors of the article conclude that the incidence of residual blockade in Spain is similar to that published in other settings and countries. A total of 763 patients from 26 hospitals were included; of these, 190 patients (26.7%) experienced residual paralysis. The absence of a bedside system that objectively can monitor neuromuscular function is associated with worse outcome for patients. Moreover, the absence of reversal drugs and reversal with neostigmine resulted in an increased incidence of respiratory events, placing the patients at significant risk of morbidity and mortality. This strongly suggests that empiric reversal with neostigmine that is not guided by the depth of block at the time of reversal does not protect patients from postoperative residual block. The findings underscore the need for solutions such as the TetraGraph System that will protect patients from the critical respiratory complications associated with residual neuromuscular block.
Lena Söderström, CEO of Senzime AB Tel: +46 708-16 39 12, email: firstname.lastname@example.org
TO THE EDITORS
Senzime develops patient oriented systems enabling automated and continuous monitoring of vital substances such as glucose and lactate in blood and tissue. Based on Senzime's patented biosensor technology, the company offers complete patient monitoring systems for the health care market. Senzime's products consist of the CliniSenz Analyzer and OnZurf Probe that make it possible, among other things, to detect post-operative complications significantly earlier than by conventional methods, thus contributing to improved patient care and lower health care costs. The company's share is listed on Aktietorget, Stockholm. www.senzime.com
About Acacia Designs
Acacia Designs is an international development company founded by leading clinicians and developers within the field of anesthesia. The company originates from research at Mayo Clinic, USA, the largest integrated noncommercial medical institution in the world and in 2015 ranked as the world's best hospital. Acacia has developed TetraGraph – a unique system for objective monitoring of patients undergoing anesthesia and the use of neuromuscular blocking agents (NMBAs). The system makes it possible to objectively determine the right dose of medication and when it is safe to wake the patient and allow for spontaneous breathing following surgery. Every year more than 20 million patients are affected by post-operative complications related to the use of NMBAs and premature extubation. The TetraGraph is intended to easily and precisely improve the monitoring of these patients to reduce complications and healthcare costs. Objective monitoring of patients receiving NMBAs is an established practice in several countries such as Scandinavia and France, and number of initiatives are underway to establish the method as Standard of Care. Acacia was founded in 2014 by Prof. Sorin J. Brull and Dr. David R. Hampton based on many years of research and development. www.acaciadesigns.eu
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