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Comparison of phonomyography with balloon pressure mechanomyography to measure contractile force at the corrugator supercilii muscle

[Comparaison de la phonomyographie et de la mécanomyographie avec ballonnet sous pression pour mesurer la force contractile du muscle sourcilier]

From the Neuromuscular Research Group, Department of Anesthesiology, Centre hospitalier de l’université de Montréal (CHUM), Hôtel-Dieu, Université de Montréal, Montréal, Québec, Canada.

Address correspondence to: Dr. T.M. Hemmerling, Department of Anesthesiology, Centre hospitalier de l’université de Montréal (CHUM), Hôtel-Dieu, 3840 rue St. Urbain, Montréal, Québec H2W 1T8, Canada. Phone: 514-890-8000, ext. 14570; Fax: 514-412-7222; E-mail: thomashemmerling{at}hotmail.com

Purpose: Phonomyography is based on the creation of low frequency sounds during muscle contraction, which can be recorded and used for neuromuscular monitoring. In this study, balloon pressure mechanomyography, a novel method to measure the force of contraction via pressure changes in an air-filled balloon, was compared with phonomyography to determine neuromuscular blockade at the corrugator supercilii muscle.

Method: After approval of the Ethics Committee and informed consent, 15 patients were studied. A small condenser microphone was taped to the area just above the eyebrow for phonomyography; an air-filled balloon was taped to the area just above the opposite eyebrow. After induction of anesthesia using remifentanil and propofol, a laryngeal mask airway was inserted without the aid of neuromuscular blocking agents. The facial nerve was stimulated supramaximally with single-twitch stimulation (0.1 Hz) using superficial electrodes placed on both temporal areas for onset and train-of-four stimulation every 12 sec during offset of neuromuscular blockade produced by mivacurium 0.1 mg•kg^-1. Onset and recovery measured by the two methods were compared using the t test and agreement between phonomyography and balloon pressure mechanomyography was examined using the Bland-Altman method.

Results: Onset, peak effect, and time to reach 25%, 75%, and 90% of control twitch response for phonomyography vs balloon pressure method were 83 ± 16 sec vs 81 ± 15 sec, 80 ± 15% vs 82 ± 17%, 7.7 ± 2.3 min vs 7.5 ± 2.4 min, 9.9 ± 4.1 min vs 10.5 ± 4 min, and 12.6 ± 4.3 min vs 13.1 ± 4.5 min respectively without being significantly different. Mean bias was 1% with limits of agreement of -9 and +9% of twitch height (T1).

Conclusion: We applied a balloon pressure method to measure the force at the corrugator supercilii. Phonomyography at the corrugator supercilii shows good agreement with this modified version of mechanomyography.

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