To complete this lesson, you will need:
Every time you use the Stimpod, you must first determine which site will be best suited for TOF monitoring.
There are two main considerations when selecting the site: Which appendage is available for the attachment of the accelerometer? And will the appendage be free to move without restriction?
The accelerometer can be placed anywhere on the thumb as long as it is above the knuckle.
There is a longer (3.5m) monitoring cable available for the STIMPOD that will negate the possible disadvantage of the nerve stimulator moving away from the head of the patient where most of the monitoring occurs.
The accelerometer can be placed anywhere on the big toe so long as it is above the knuckle.
Ensure accelerometer strap is the appropriate length to fit the corresponding appendage. A longer accelerometer strap is available for larger appendages.
Facial nerve monitoring has been shown to have a fivefold risk of postoperative residual curarization.1
1 Intraoperative neuromuscular monitoring site and residual paralysis. Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari MM, Bhananker SM. Anesthesiology. 2012 Nov; 117(5):964-72.
When applying the accelerometer to the face, the strap must first be removed, and double-sided tape applied to the bottom of the accelerometer.
To monitor the Corrugator Supercilli muscle, place the accelerometer on the eyebrow.
To monitor the Obicularis Oculi muscle, place the accelerometer in the eyelid.
Facial nerve monitoring should not be used in close proximity to EEG electrodes, such as BIS monitoring.