A Comparison Between Anterior and Posterior Monitoring of Neuromuscular Blockade at the Diaphragm: Both Sites Can Be Used Interchangeably
Bibliographic record
Abstract
UNLABELLED: We present a novel site of monitoring neuromuscular blockade of the diaphragm at the patient's back. After the induction of anesthesia, 12 patients were orotracheally intubated. Two Ag/AgCl-electrodes were attached at the right seventh or eighth intercostal space between the midclavicular and anterior axillary line; two Ag/AgCl-electrodes were paravertebrally attached on the right side lateral to vertebrae T12-L1 or L1-2. Two Ag/AgCl-skin-electrodes were placed over the right thenar area for an electromyography recording of the adductor pollicis (AP) muscle, and two Ag/AgCl-skin-electrodes were used to stimulate the ulnar nerve. Onset and offset of neuromuscular blockade after rocuronium 0.6 mg/kg were determined, and significant differences between diaphragm and AP muscle and agreement between the two methods were determined. Mean maximum block was more than 96% at all sites. Lag time, onset 50, and onset time were not significantly different between the diaphragm and the AP. However, time to reach 25% of control twitch was significantly longer at the AP muscle than at the diaphragm (P < 0.001). The difference of the means and limits of agreement between the anterior and the posterior site of diaphragmatic monitoring were 0 +/- 11 s, 3 +/- 9 s, 0 +/- 19 s, and -2% +/- 5% for lag, onset 50, onset time, and peak effect, respectively, and -2 +/- 2 min for the time to reach 25% of control twitch of neuromuscular blockade. We conclude that anterior and posterior diaphragmatic monitoring can be used interchangeably to determine neuromuscular blockade after rocuronium. IMPLICATIONS: We present a novel site of monitoring neuromuscular blockade of the diaphragm at the patient's back, which shows good agreement with the conventional anterior site at the seventh or eighth intercostal space.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".