Utilizing EMG Technology to Help Reduce the Incidence of Residual Paralysis

Neuromuscular blocking agents (NMBA’s) are key in many surgeries, helping to not only facilitate intubation, but also maintain optimal conditions throughout the procedure. Yet, as important as the use of these medications are, the risks faced due to their use are very real, including residual paralysis, a condition which is associated with respiratory complications such hypoxemia, aspiration, and airway obstruction. Without full reversal of the agents, patients may also require tracheal intubation, leading to a lengthier stay in the postanesthesia care unit (PACU) and delaying recovery while increasing costs for hospitals¹.

While techniques like head lift and grip strength may be used to monitor the patient’s neuromuscular function under anesthesia, they provide an incomplete and unreliable picture of the level of the block. For this reason, quantitative neuromuscular transmission (NMT) monitoring via electromyography (EMG) is recommended, whenever neuromuscular blocking agents are utilized.

EMG – the gold standard in NMT monitoring

EMG is the preferred choice for NMT monitoring due its ability to directly measure electrical activity close to the site of action of the NMB agents. Unlike other NMT options, including kinemyography (KMG) and acceleromyography (AMG), which can require access to and movement of the hand, EMG provides a high quality signal even if the hand is completely immobilized. It can also be used to measure recovery to achieve safe extubation.

Improving patient care and the bottom line with EMG monitoring

Using EMG to measure the neuromuscular blockade provides clear benefits to both patients and hospitals. These include:

Faster recovery

EMG measurement aids in the complete reversal of NMBAs to support early mobilization, avoid residual paralysis and adverse respiratory events. For patients, this means an accelerated path to recovery and normalcy.

Hospitals win big when faster recovery times are achieved as well. In fact, studies have shown that using EMG may help expedite patient throughput and PACU discharge^[1]. When you consider that every minute in PACU rings in at a cost of up to $6, this is a benefit that organizations can’t afford to ignore.

Improved patient well-being and comfort

Additionally, the use of EMG monitoring during anesthesia delivers high level benefits for patient safety and comfort. As we already talked about, studies have found the EMG utilization may help minimize adverse events associated with residual paralysis^[2].

EMG also enhances patient safety and comfort by helping clinicians achieve adequate neuromuscular block and guide a proper injection and dosage of antagonists, often used inappropriately and leading to suboptimal efficacy and increased reversal costs.

A better bottom line

The financial benefits of EMG measurement only add to its importance. In addition to the potential for accelerated throughput and PACU discharge that may be achieved with EMG technology, use of this gold-standard in adequacy of anesthesia may also help hospitals:

Reduce the consumption and cost of NMBAs
Optimize timing and choice of NMB (neuromuscular block) reversal agents
Decrease adverse events and costly interventions/ICU admissions due to possible reintubation

Utilizing EMG also allows hospitals to ensure they are practicing emerging standards in anesthesia while enabling APSF endorsement for objective neuromuscular monitoring.

References

[1] Postoperative residual curarizationfrom intermediate-acting neuromuscular blocking agents delays recovery room discharge, A. ButterlyE. A. Bittner E. George W. S. Sandberg M. EikermannU. Schmidt, BJA: British Journal of Anaesthesia, September 2010

[2] The Implementation of Quantitative Electromyographic Neuromuscular Monitoring in an Academic Anesthesia Department, Todd, Michael M. MD; Hindman, Bradley J. MD; King, Brian J. BA, Anesthesia & Analgesia, August 2014