Neuromuscular Transmission (NMT)

awareness monitoring neuromuscular junction nmt recovery room emeregencies reversal Aug 29, 2024
Why is the patient making jerky movements in recovery? ๐Ÿค”
 
Have you ever seen a patient emerging from anaesthesia without adequate reversal of muscle relaxant? Some studies suggest that this occurs in up to 40% of patients undergoing general anaesthesia with muscle relaxant. Here’s what you need to know about how and why we monitor the neuromuscular junction (NMJ):
 
Muscle relaxants:
 
The NMJ is the gateway between the motor nerve and the muscle cells. If you imagine this gateway is a highway, and giving muscle relaxant acts as a roadblock . At first, the roadblock is blocking ALL the cars on the highway, but as the muscle relaxant wears off, more and more cars can resume their journey along the highway. If you wake a patient up before the highway has been fully reopened, the patient will be at risk of serious complications. ๐Ÿš—๐Ÿš™๐Ÿš๐Ÿšง
 
Monitoring:
 
To ensure this highway has been fully reopened, we can apply a neuromuscular transmission (NMT) monitor to the patient. The most common method is using a “train of four” count and ratio. Essentially, we send some electrical signals down the motor nerve and test how strong the muscle response is. It’s like taking a photo of the highway prior to the roadblock, then taking a photo after the roadblock and comparing the two. If ALL the cars are getting through, your patient is fully reversed. If only some cars are making it through, you need to give more reversal or keep the patient anaesthetised for longer!
 
What does this mean? ๐Ÿฅต
 
Given the risk of inadequate reversal, your team should always enquire about reversal prior to waking the patient . Although reversal agents, especially sugammadex, are very effective, the only way to be certain that your patient is reversed is to apply NMT monitoring and test the neuromuscular junction. ๐Ÿงช๐Ÿ”
 
Build knowledge โœ…
Improve safety โœ…
 
Ref: https://www.bjaed.org/article/S1743-1816(17)30405-5/fulltext

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