BLINK TWITCHVIEW TRAIN OF FOUR MONITOR

Description of Event or Problem

I ATTEMPTED TO USE THE BLINK TWITCHVIEW TRAIN OF FOUR MONITOR TO MONITOR NEUROMUSCULAR BLOCKADE IN MY PATIENT. OF NOTE, SHE HAD ANASARCA. ALTHOUGH THE EMG ELECTRODES WERE PROPERLY POSITIONED AND THE DEVICE WAS PROPERLY EVOKING VIGOROUS MOVEMENTS OF THE THUMB, ONLY WEAK (PEAK ~1 MV) EMG SIGNALS WERE DETECTED AT 80MA. I ATTRIBUTED THIS PROBLEM TO EDEMA ALTERING THE CONDUCTIVE PROPERTIES OF THE TISSUES BETWEEN THE PATIENT'S MUSCLES AND SKIN. FOR THE REMAINDER OF THE OPERATION, I USED THE DEVICE AS A NERVE STIMULATOR ONLY, ASSESSING THE DEGREE OF NEUROMUSCULAR BLOCK BY VISUAL AND MANUAL OBSERVATION OF THE THUMB.