Tof watch sx

None of the participants received pre-medication. After admission to the operating room, patients received standard hemodynamic monitoring for general anesthesia, including bispectral index monitoring and TOF monitoring (TOF-watch SX, Organon, Ireland). Inhalational induction was started with 5% sevoflurane for participants younger than 14 years old, and standard induction with propofol (1–2 mg/kg body weight) or thiopental (3–5 mg/kg body weight) was performed in participants 14 years old or older. Intravenous cannulation was achieved on the dorsal part of the hand or dorsal side of the forearm. Rocuronium (0.9 mg/kg) was injected after confirming loss of consciousness by loss of the eyelash reflex and a bispectral index less than 60. The MR13A10A group received MR13A10A, and the original rocuronium group received original rocuronium. Intravenous opioid injection and tracheal intubation were performed after the observation period.

Neuromuscular function was monitored according to the established guidelines from Good Clinical Research Practice (GCPR) for pharmacodynamic neuromuscular studies [15 (link)]. The acceleromyograph TOF-Watch SX was connected to a computer for collection of neuromuscular data (Version 2.5 INT 2007; Organon, The Netherlands). Two ECG electrodes (Ambu® BlueSensor N; Copenhagen Denmark) were placed over the ulnar nerve on the wrist after cleaning the skin with a disinfectant wipe. The acceleration transducer was placed on the thumb with a hand adaptor and upon loss of eyelash reflexes the TOF Watch SX was started. Two TOF nerve stimulations were given, followed by tetanic stimulation with 50 Hz for 5 seconds. Calibration was performed with the CAL button and neuromuscular function was monitored by TOF stimulation (2 Hz for 1.5 s) every 15 s. Neuromuscular data were pseudo-anonymized and stored on a drive.

Neuromuscular blockade in supine patients was assessed using acceleromyography (TOF-Watch® SX, Organon Ireland Ltd., a subsidiary of Merck & Co., Inc., Swords, Co. Dublin, Ireland) at the adductor pollicis muscle. The upper forearms were positioned with a supinated palm and secured onto an arm board. The skin surface was prepared by abrading and cleaning with an alcohol swab, followed by air drying. TOF-Watch electrodes were placed at specific locations: the distal electrode at the intersection between the radial border of the flexor carpi ulnaris muscle and the proximal margin of the wrist curve, and the proximal electrode positioned 2–3 cm away from it. Additionally, two surface electrodes were attached to the forearm where the ulnar nerve is located. The transducer position was secured using a hand adapter, with a temperature sensor affixed to the distal end of the forearm. To maintain a minimum arm temperature of 32°C, the patient was draped with warming blankets. Calibration of the TOF Watch was performed once the BIS value dropped below 60 for each patient before administering muscle relaxants during anesthesia induction. Throughout the surgery, TOF stimuli were repeated every 15 s. Deep neuromuscular blockade was defined as no response to TOF stimulation but a response to post-tetanic-count (PTC) stimulation (1 to 2) (16 (link)).

NMT monitoring was established and continuously monitored using TOF-Watch SX^® (Organon, Dublin, Ireland) with TOF stimulation according to the Good Clinical Research Practice guidelines for neuromuscular blocking agents^{12 (link)}. A hand adapter with a thumb clip for preload was attached to the hand using an elastic band and adhesive tape.
The attending anesthesiologist opened the sealed envelope after the induction of anesthesia and before changing the position of the patient. To maintain the correct position of the transducer and avoid interference, the hand and wrist used for NMT monitoring were fixed with a splint, except for the thumb.
All NMT monitoring data were saved on a personal computer using TOF-Watch SX^® Monitor Software Version 2.2 (Organon). The skin temperature of the hand was measured and maintained above 32 °C. The central temperature was continuously monitored at the lower esophagus and kept above 35.5 °C.

All enrolled patients were injected with 1 mg of penehyclidine hydrochloride 30 min before surgery. Routine monitoring including electrocardiography, heart rate, non-invasive blood pressure, pulse oximetry, bispectral index (BIS), and TOF-Watch-SX (Organon, Oss, The Netherlands) were applied. All patients received total intravenous anesthesia. The anesthesia protocols in the two groups were as follows: Patients in the control group were induced with midazolam (0.05 mg/kg), sufentanil (0.3 µg/kg), propofol (2.0 mg/kg), and rocuronium (0.8 mg/kg) and were maintained with a target-controlled infusion (TCI) of propofol (4–6 mg·kg^− 1·h^− 1) and remifentanil (0.2–0.6 ug·kg^− 1·min ^− 1). Patients in the S-ketamine group were induced with midazolam (0.05 mg/kg), S-ketamine (0.5 mg/kg), propofol (2.0 mg/kg), and rocuronium (0.8 mg/kg) and maintained with a TCI of propofol (4–6 mg·kg^− 1·h^− 1), remifentanil (0.2–0.6 ug·kg^− 1·min ^− 1), and S-ketamine (0.5 mg·kg^− 1·h^− 1). The anesthetic administration rate was adjusted to the study protocol’s maintenance dose aiming for a BIS of 40–60 and mean arterial pressure (MAP) within 20% of the preoperative baseline values. After surgery all patients were transferred to the post-anesthesia care unit (PACU) for recovery.