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Shannon L. Adkins - One of the best experts on this subject based on the ideXlab platform.
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Posttetanic Count Revisited: Are Measurements More Reliable Using the TOF-Watch Accelerographic Peripheral Nerve Stimulator?
Journal of Clinical Monitoring and Computing, 2004Co-Authors: Robert D. Jr. Vincent , Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective. Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods. The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results. Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator ( p = NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) ( p < 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator ( p < 0.05). Conclusions. Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
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posttetanic count revisited are measurements more reliable using the tof watch accelerographic peripheral nerve stimulator
Journal of Clinical Monitoring and Computing, 2003Co-Authors: R D Vincent, Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective.Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods.The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results.Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator (p= NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) (p< 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator (p< 0.05). Conclusions.Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
Gregory W Randolph - One of the best experts on this subject based on the ideXlab platform.
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safety and reliability of a handheld stimulator for neural monitoring during thyroid surgery
Laryngoscope, 2020Co-Authors: Bradley R Lawson, Dipti Kamani, Mohamed Shama, Natalia Kyriazidis, Gregory W RandolphAbstract:OBJECTIVE: The Checkpoint nerve stimulator (Checkpoint Surgical, Cleveland, OH) is a U.S. Food and Drug Administration-approved device for neural localization and monitoring during surgery. Its safety, efficacy, and reliability for neural monitoring during thyroid and parathyroid surgery have not been compared to more standard formats of neural monitoring. STUDY DESIGN: Retrospective review. METHODS: Vagal, recurrent, and superior laryngeal nerve monitoring were performed using both the Checkpoint stimulator and Medtronic NIM 3.0 laryngeal electromyography endotracheal tube (Medtronic, Jacksonville, FL) during thyroid and parathyroid surgery. A total of 21 operated sides in 15 patients were included for analysis. Latency and amplitude data for the Checkpoint stimulator were recorded using the NIM monitor and compared to normative endotracheal tube surface electrode data. RESULTS: Mean amplitude using the Checkpoint stimulator was 574.6 microvolts (μV), 1060.6 μV, and 182.8 μV for the vagus, recurrent laryngeal, and superior laryngeal nerves, respectively. Mean amplitude using standard laryngeal electromyography was 709 μV, 1077.0 μV, and 183.7 μV for the same nerves. Mean latency was significantly shorter with stimulation of the recurrent laryngeal nerve compared to the vagus nerve with both Stimulators (P < 0.001). No neural injuries occurred during the study. CONCLUSION: The Checkpoint stimulator is a safe and reliable alternative to traditional laryngeal electromyography providing equivalent induced electromyography of the vocalis for neural monitoring during thyroid and parathyroid surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.
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superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries
Laryngoscope, 2014Co-Authors: Ashlie E Darr, Dipti Kamani, Gregory W Randolph, Ralph P Tufano, Suleyman Ozdemir, Shelley HurwitzAbstract:Objectives/Hypothesis To report normative electromyography (EMG) data on the external branch of the superior laryngeal nerve (EBSLN) and to compare this to analogous data of the recurrent laryngeal nerve (RLN) and vagus nerve (VN) during intraoperative neural monitoring (IONM) using both the standard monopolar stimulator probe and a novel bipolar stimulator probe. Study Design Prospective multiple tertiary care center study. Method A prospective study of EBSLN, RLN and VN EMG data in 22 thyroid surgeries was performed. Subjects with preoperative vocal fold paralysis were excluded. Postoperative laryngoscopy was normal in all subjects. Normative EMG data were acquired using both a standard monopolar and a novel bipolar stimulator probe, as well as a novel endotracheal tube. Cricothyroid muscle (CTM) twitch response during EBSLN stimulation was analyzed. Results In 100% of cases, EBSLN was identified and quantifiable EMG response was observed. EMG amplitude did not change despite extensive nerve dissection and multiple nerve stimulations. EBSLN amplitude was similar for left and right sides for patients under age 50 and aged 50 or older, for both genders, and with monopolar and bipolar Stimulators. Conclusions Intraoperative neural monitoring may be used to safely assist in EBSLN identification during thyroid surgery in 100% of patients. A novel endotracheal tube allows for quantifiable EBSLN EMG activity in 100% of cases. Monopolar and bipolar stimulator probes produce similar EMG data. Level of Evidence 4. Laryngoscope, 124:1035–1041, 2014
Russell C. Brockwell - One of the best experts on this subject based on the ideXlab platform.
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Posttetanic Count Revisited: Are Measurements More Reliable Using the TOF-Watch Accelerographic Peripheral Nerve Stimulator?
Journal of Clinical Monitoring and Computing, 2004Co-Authors: Robert D. Jr. Vincent , Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective. Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods. The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results. Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator ( p = NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) ( p < 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator ( p < 0.05). Conclusions. Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
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posttetanic count revisited are measurements more reliable using the tof watch accelerographic peripheral nerve stimulator
Journal of Clinical Monitoring and Computing, 2003Co-Authors: R D Vincent, Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective.Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods.The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results.Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator (p= NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) (p< 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator (p< 0.05). Conclusions.Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
Michael C. Moreno - One of the best experts on this subject based on the ideXlab platform.
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Posttetanic Count Revisited: Are Measurements More Reliable Using the TOF-Watch Accelerographic Peripheral Nerve Stimulator?
Journal of Clinical Monitoring and Computing, 2004Co-Authors: Robert D. Jr. Vincent , Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective. Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods. The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results. Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator ( p = NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) ( p < 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator ( p < 0.05). Conclusions. Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
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posttetanic count revisited are measurements more reliable using the tof watch accelerographic peripheral nerve stimulator
Journal of Clinical Monitoring and Computing, 2003Co-Authors: R D Vincent, Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective.Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods.The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results.Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator (p= NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) (p< 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator (p< 0.05). Conclusions.Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
R D Vincent - One of the best experts on this subject based on the ideXlab platform.
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posttetanic count revisited are measurements more reliable using the tof watch accelerographic peripheral nerve stimulator
Journal of Clinical Monitoring and Computing, 2003Co-Authors: R D Vincent, Russell C. Brockwell, Michael C. Moreno, Shannon L. AdkinsAbstract:Objective.Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. Methods.The TOF-Watch and Digi Stim III peripheral nerve Stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg IV in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. Results.Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator (p= NS). Among Stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) (p< 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator (p< 0.05). Conclusions.Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.
