TetraGraph is the preferred monitor for robotic-assisted surgeries, ensuring profound and complete muscle relaxation.
Quantitative monitoring significantly reduces intraoperative complications compared to visual or tactile assessment methods. (Weigel et al., 2022)
Quantitative TOF monitoring: The ideal partner in tucked-arm cases
Over 80% of robotic surgeries rely on neuromuscular blocking agents (NMBAs) to maintain optimal conditions.
TetraGraph offers anesthesiologists the gold standard in EMG-based quantitative train-of-four (TOF) monitoring, ensuring profound and/or complete muscle relaxation and optimal conditions for robotic procedures.
Enhanced immobility for robotic precision
- Eliminate patient movement
The TetraGraph system ensures complete neuromuscular block, preventing any involuntary patient movement during surgery, while preventing neuromuscular blocking agent (NMBA) overdosing. This is critical for the immobility required in robotic-assisted surgeries.
- Robotic precision and surgeon control
Robotic systems rely on precise, controlled movements. Even small involuntary patient movements can interfere with the alignment of robotic instruments and compromise the accuracy and safety of the procedure.
Optimal recovery and patient outcomes
- Reduced postoperative residual neuromuscular block
Without TOF monitoring, residual block incidence is between 33% (Carvalho et al., 2020) and 65% (Fortier LP et al., 2015). Using quantitative monitoring, anesthesiologists can guarantee a TOFR >0.90 prior to tracheal extubation, reducing pulmonary complications by 43% (Weigel et al., 2022).
- Shorter hospital stays
Patients quantitatively monitored experience a 1-day reduction in hospital length of stay, optimizing recovery and lowering healthcare costs (Weigel et al., 2022).
Cost-effective anesthesia management
- Enabling precision dosing
Quantitative monitoring enables accurate dosing of reversal agents like sugammadex. In a recent study, 87% of patients required less sugammadex than the recommended dose, and 13% required more (Bowdle et al., 2023).
- Increased efficiency
Quantitative monitoring shortens PACU discharge times, optimizing turnover and resource allocation (Iwasaki H., 2020; Haberkorn S, 2024).
Improved clinical outcomes
- Reduced pulmonary complications
Achieving TOFR >0.90 reduces complications, including pneumonia and reintubation (Weigel et al., 2022).
- Ensured patient safety
Quantitative monitoring eliminates residual block in 100% of cases, compared to a 16% incidence without monitoring when using sugammadex (Domenech et al, 2019) (Kotake, 2013).
Even when the recommended dose of sugammadex is administered under qualitative (subjective) assessment, residual neuromuscular block in the recovery room occurs frequently, indicating that quantitative monitoring is necessary for best patient outcome.
(Koo CH, 2024)
Next-generation TetraGraph
Your portable EMG monitor for accurate measurements
Higher precision than acceleromyography (AMG) as TetraGraph measures the compound muscle action potential (CMAP).
Unlike traditional monitoring techniques like acceleromyography (AMG),
TetraGraph EMG can function without requiring unimpeded thumb movement during surgery, enabling flexibility in arm positioning, such as tucking arms under surgical drapes.
Superior algorithm validated for accuracy against MMG (mechanomyography) at all levels of block, with integrated noise-canceling technology ensuring precise measurements without the need for extra electrodes.
Learn more about monitoring in robotic-assisted surgery
References
Internal Data Analysis on File
Hernandez V, Chavez-Cardona H, Renew JR, Brull SJ. Electromyographic And Acceleromyographic Monitoring In Restricted ArmMovement Surgical Setting. A Prospective, Randomized Trial. Anesthesiology 2021;A2069.
Weigel WA, Williams BL, Hanson NA, et al. “Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative.” Anesthesiology, 2022; 136(6):901-915. DOI: 10.1097/ALN.0000000000004174.
Carvalho H, et al.: Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta-analysis and evaluation of confidence in network meta-analysis. Br J Anaesth. 2020 Oct;125(4):466-482.
Fortier LP, McKeen D, Turner K, et al. The RECITE study: a Canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade. Anesth Analg 2015; 121: 366e72
Iwasaki H, Kurosawa A, Iida T, Sasakawa T, Kanda H. The use of intraoperative neuromuscular monitor reduces the reversal dose of sugammadex: a single-center retrospective study. J Anesth 2020; 34:276-280.
Haberkorn S, Twite M, Klockau K, Whitney G, Faulk DJ. Quantitative monitoring maximizes cost-saving strategies when antagonizing neuromuscular block with sugammadex. Cureus 2024; 16(9):e68551.
Bowdle TA, Haththotuwegama KJ, Jelacic S, Nguyen ST, Togashi K, Michaelsen KE. A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis. Anesthesiology. 2023 Jul 1;139(1): 6-15. doi: 10.1097/ALN.0000000000004578. PMID: 37027807.
Koo CH, Lee S, Yim S, Bae YK, Park I, Oh AY. Is quantitative neuromuscular monitoring mandatory after administration of the recommended dose of sugammadex? A prospective observational study. Anaesth Crit Care Pain Med 2024; 43:101445.
Domenech, G., Kampel, M.A., García Guzzo, M.E. et al. Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study. BMC Anesthesiol 19, 2019.
Kotake, Y. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth. Analg, 2013.