Kinemyography (KMG) Versus Electromyography (EMG) Neuromuscular Monitoring in Pediatric Patients Receiving Rocuronium during General Anesthesia

There are a limited number of studies that compared kinemyography (KMG) and mechanomyography in the clinical practice but few studies compared KMG to electromyography (EMG) either in adults and none in children. This study compared the time course data for rocuronium relaxation measured by KMG to that measured by EMG in children 2- 6 years old. Methods: 24 children ASA I or II of both sexes, aged 2- 6 years, scheduled for elective surgery under GA were included in the study. Premed with midazolam 0.3mg/kg orally. Monitoring included ECG, NIBP, pulse oximetry, capnography, anesthetic gas monitor and temperature. NMT monitoring consisted of attaching the pediatric KMG sensor (NMT mechanosensor, for Datex GE, S5) in one hand, while the other hand had a 5 lead EMG (EMG for Datex GE, S5) for simul-taneous recoding of both modalities. Anesthesia was induced with fentanyl 2μg/kg and propofol 2μg/kg followed by endotracheal intubation. Ventilation was maintained by endtidal isoflurane 1.2% in 50% oxygen/air to maintain endtidal CO² 32-35mmHg. After 3 minutes of stable supramaximal stimulation, a train of four stimulus was applied every 15sec. each patient had a single dose of 0.6mg/kg rocuronium. The following parameters were collected (1) Lag time, (2) Onset time, (3) Assessing the recovery period by; train of four (TOF) 0.25, 0.50, 0.75 and 0.90. No top-up doses of rocuronium were given. Statistical analysis was done as appropriate. Results: There were no statistically significant differences in the lag time, the onset time, TOF 0.25, 0.5, 0.75 and 0.9 ratios using either EMG or KMG. In addition, there was an excellent degree of agreement between EMG and KMG in measuring TOF ratio during both induction and recovery of rocuronium. Conclusion: KMG showed an excellent degree of agreement with EMG for determination of onset and recovery of a single dose of rocuronium in children. For clinical purposes, time course data obtained from KMG can be interchanged with that data obtained from EMG using rocuronium in children. The KMG is easy to use and can guide the clinician in assessing onset and recovery of rocuronium in children.