Acceleromyography Monitoring With Preload Hand Adapter
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An acceleromyograph is a
piezoelectric Piezoelectricity (, ) is the electric charge that accumulates in certain solid materials—such as crystals, certain ceramics, and biological matter such as bone, DNA, and various proteins—in response to applied Stress (mechanics), mechanical s ...
myograph A myograph is any device used to measure the force produced by a muscle when under contraction. Such a device is commonly used in myography, the study of the velocity and intensity of muscular contraction. A myograph can take several forms: for ...
, used to measure the force produced by a
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
after it has undergone nerve stimulation. Acceleromyographs may be used, during anaesthesia when muscle relaxants are administered, to measure the depth of neuromuscular blockade and to assess adequacy of recovery from these agents at the end of surgery. Acceleromyography is classified as quantitative
neuromuscular monitoring In anesthesia, neuromuscular blocking agents may be required to facilitate Tracheal intubation, endotracheal intubation and provide optimal surgical conditions. When neuromuscular blocking agents are administered, neuromuscular function of the pati ...
.


Rationale

Patients who undergo anesthesia may receive a drug that paralyzes muscles, facilitating endotracheal intubation and improving operating conditions for the surgeon. Longer-acting drugs have higher prevalence of residual blockade in the PACU or ICU than shorter acting drugs. Different clinical tests to measure or exclude evidence of residual
muscle weakness Muscle weakness is a lack of muscle strength. Its causes are many and can be divided into conditions that have either true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, includi ...
have been described but cannot exclude
postoperative residual curarization Postoperative residual curarization (PORC) or residual neuromuscular blockade (RNMB) is a residual paresis after emergence from general anesthesia that may occur with the use of neuromuscular-blocking drugs. Today residual neuromuscular blockade ...
. Small degrees of muscle blockade can only accurately be measured by the use of quantitative neuromuscular monitoring. Specifically, the observer cannot reliably measure muscular fade when
train-of-four In anesthesia, neuromuscular blocking agents may be required to facilitate endotracheal intubation and provide optimal surgical conditions. When neuromuscular blocking agents are administered, neuromuscular function of the patient must be monitore ...
ratios are between 0.4 and 0.9.


Acceleromyograph design

Acceleromyographs measure muscle activity using a miniature
piezoelectric transducer Piezoelectricity (, ) is the electric charge that accumulates in certain solid materials—such as crystals, certain ceramics, and biological matter such as bone, DNA, and various proteins—in response to applied mechanical stress. The word ''p ...
that is attached to the stimulated muscle. A voltage is created when the muscle accelerates and that acceleration is proportion to force of contraction. The mass of the piezoelectric transducer is known and the acceleration is measured therefore the force can be calculated, (
Force In physics, a force is an influence that can change the motion of an object. A force can cause an object with mass to change its velocity (e.g. moving from a state of rest), i.e., to accelerate. Force can also be described intuitively as a p ...
=
mass Mass is an intrinsic property of a body. It was traditionally believed to be related to the quantity of matter in a physical body, until the discovery of the atom and particle physics. It was found that different atoms and different elementar ...
×
acceleration In mechanics, acceleration is the rate of change of the velocity of an object with respect to time. Accelerations are vector quantities (in that they have magnitude and direction). The orientation of an object's acceleration is given by the ...
). Acceleromyographs are more costly than the more common twitch monitors, but have been shown to better alleviate residual blockade and associated symptoms of muscle weakness, and to improve overall quality of recovery.


See also

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Muscle relaxant A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeu ...
*
Myograph A myograph is any device used to measure the force produced by a muscle when under contraction. Such a device is commonly used in myography, the study of the velocity and intensity of muscular contraction. A myograph can take several forms: for ...
*
Neuromuscular-blocking drug Neuromuscular-blocking drugs block neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. This is accomplished via their action on the post-synaptic acetylcholine (Nm) receptors. In cl ...
*
Neuromuscular monitoring In anesthesia, neuromuscular blocking agents may be required to facilitate Tracheal intubation, endotracheal intubation and provide optimal surgical conditions. When neuromuscular blocking agents are administered, neuromuscular function of the pati ...


References

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External links


Comparison of mechanomyography and acceleromyography in myotonic dystrophy type 1
at Respond2Articles.com Anesthesia Muscular system Medical devices