Background and Goal of Study: The risk of postoperative residual curarisation can be eliminated by the correct use of acceleromyography (AMG) (1). Furthermore, its peroperative use insures adequate surgical relaxation. The only requirement is that the thumb must be allowed free movement. This is frequently impossible during surgical procedures.
We investigated the clinical feasibility of AMG protected inside a new device: the TOF-tube (2).
Materials and Methods: The rigid and tubular TOF-tube allows safe positioning of the hand while ensuring thumb mobility under the surgical sheets (Fig. 1).
We asked 8 TOF-tube-unexperienced anaesthetists to answer 4 questions concerning their first few clinical uses of the device.
Results and Discussions: The patients (n = 64) underwent various types of surgery (including gynaecological, abdominal, cardiac, ENT, orthopaedic) in supine position (95%) with the arm alongside the body (76%) or on an armboard.
TOF-tube is easy to set up: yes (93.75%)
Stability during operation: yes (92.19%)
You believed in the measurements: yes (93.75%)
You used them to adapt the depth of blockade or to ensure full recovery: yes (92.19%)
The patients never complained. Few surgeons did (n = 2).
The most frequent comment concerned the bulkiness in gynaecological position with the arm alongside the body, and the lost of measurement when the piezzoelectric crystal fell from the thumb during operation.
Conclusions: In daily practice, TOF-tube improves the functioning of AMG in various types of surgery and installations. Further improvements of the device will occur taking comments into account.
1 Eriksson L.I. Evidence-based practice and NM monitoring. Anesthesiology 2003;98: 1037-9.
2 Dubois P.E., Broka S.M., Joucken K.L. TOF-tube. Anesth Analg 2000;90:232-3.