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  • Acceleromyography neurological monitors designed to continuously identify, measure, and display the level of muscle relaxation of patients under the influence of neuromuscular blocking agents during surgical procedures. These monitors typically consist of a computerized unit including controls, a display, and three detachable leads. Two leads have electrodes at the distal tips that are placed on the ulnar nerve to provide the electrical stimuli, the third lead with an accelerometer (i.e., acceleration to voltage transducer) at the distal tip is located on the volar site of the thumb. The measure of the acceleration when stimuli are applied is proportional to the force exerted by the movement of the thumb. Several types of stimuli may be provided, including: (1) single stimulus whose response may be compared to a reference; (2) series of four impulses (known as train of four [TOF]); and (3) post-tetanic count: tetanic stimulation, followed by single stimuli at one-second intervals with counting of the number of responses to the one-second stimuli. Intraoperative acceleromyography monitors are intended for a better control in the administration of the neuromuscular blocking agents required during anesthesia and the possible reduction in the post-operative incidence of neuromuscular weakness; the monitors may be used also in patients under mechanical ventilation.
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