EMG – The new Gold Standard in NMT monitoring

Like other technologies, EMG involves stimulation of a peripheral nerve and measurement of the response that is generated by the contraction of the innervated muscle. The difference from other technologies is that EMG measures an electrical event that occurs at the neuromuscular junction; the activation of postsynaptic receptors by acetylcholine (a chemical process) that converts it to a mechanical response (excitation- contraction coupling), that results in muscle contraction. Because measurement of function does not depend on physical movement (as MMG, AMG or KMG require), EMG is a better indicator of pure neuromuscular function.


Neuromuscular Transmission Stages and related Neuromuscular Transmission Technologies

Neuromuscular Transmisson (NMT) is the transfer of an impulse between a nerve and a muscle in the neuromuscular junction. EMG measures the compound action potential, which is the first signal we are able to meaure after neuromuscular transmission. Therefore, EMG is most specifically suited to monitor the effect of muscle relaxants without any mechanic interferences.


REFERENCES

Salminen J et al. Comparison of train-of-four ratios measured with Datex-Ohmeda´s M-NMT mechano-sensor and M-NMT electro-sensor. Journ of Clin Monitoring and Computing, 2016; 30(3),295-300
Naguib M, et al. Consensus Statement on perioperative Neuromuscular Monitoring. Anest Analg. 2018; 127(1):71-80
Naguib et al. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia 2017;72:16-37
Liang SS, et al. An ipsilateral comparison of acceleromyography and electromyography during recovery from nondepolarizing neuromuscular block under general anesthesia in Humans. Anesth Analg 2013; 117:373-9
Murphy GS. Neuromuscular Monitoring in the Perioperative Period. Anesth Analg 2018; 126:464-468