Muscular relaxation monitoring of patient under neuromuscular blocking agent
During surgical interventions, curare is administered to patient to achieve a complete muscular relaxation. This relaxation facilitates the tracheal intubation, the surgical procedure (cutting the muscular wall) and prevents any reflex movement that may be harmful to the patient (movement of limb, swallowing, cough …).
Because the effects of the muscular relaxants show a high interindividual variability, an effective monitoring is required to adjust the dosage (curare and antagonist) specifically to the patient and determine when a patient can leave the operating room safely.
Currently, available devices on the market have implementation difficulties and a lack of objectivity. Therefore, the postoperative residual curarization is still a public health issue and partial paralysis affects 60% of patients who received curare. Recent studies have shown that residual paralysis increases by a factor of 10 the risk of severe pulmonary complications.
To quantify the muscular relaxation, every monitor works through the evaluation of muscle contractions in response to electrical stimulation of its motor nerve.
The first objective is to design a reliable and easy to use curare monitor that is suitable for clinical practice. In order to do so, this monitor must provide a reliable, accurate and reproducible measurement of the muscular tonus. It must also be able to assess the measurement quality. Two types of monitor are developed in this project: one uses the EMG measurement and the other the force measurement.
The final objective of this project is to operate the whole system in a closed loop, i.e., to regulate curare and antagonist injection as a function of the monitoring and the surgeon’s needs.