I-Corps: Quantitative Train-of-Four monitoring device for quantitatively monitoring neuromuscular blockade in patients undergoing surgery

这个i-Corps项目的更广泛的影响/商业潜力是开发一种四人训练(TOF)设备，提供一种定量监测手术患者神经肌肉阻滞的方法。神经肌肉阻滞剂(NMBAs)在手术中被广泛用于暂时瘫痪患者。目前的测量方法存在术后残留神经肌肉阻滞的风险，即手术后NMBAs仍留在体内。这种术后问题会导致肌肉无力和严重的呼吸发作。目前标准的TOF监测方法是定性的，麻醉师必须依靠他们的视力和经验来判断患者的正确剂量。建议的设备产生一个定量的输出，TOF数据，以帮助麻醉师衡量对每个患者实施多少神经肌肉阻滞剂，以及何时逆转其影响。通过确保完全的神经肌肉恢复，建议的设备将手术后体内残留的神经肌肉阻滞剂引起的呼吸道并发症和肌肉无力的不愉快症状降至最低。该设备可以防止不必要的术后压力，同时可能为医院节省资金。这个I-Corps项目基于一种机械肌肉成像设备的开发，该设备使用医用级别的气球将患者的反应转换为四人训练(TOF)数据。在该装置中，对尺神经使用周围神经刺激器会导致拇指抽动，从而对气球施加压力。这些压力波动由传感器拾取并转换为TOF数据，通过将压力作为肌肉麻木的物理模拟并将其转换为电信号，精确测量体内神经肌肉阻滞的程度。建议的设备利用机械肌肉成像，这被认为是监测神经肌肉阻滞的黄金标准和最准确的技术，因为它直接测量肌肉对尺神经刺激做出反应时产生的运动。目前市场上还没有机械肌图设备来监测神经肌肉阻滞。此外，即使在拇指活动受限的位置，例如当双手被塞在身体旁边时，所提出的设备也能评估TOF计数和TOF比率。随着腹腔镜手术的使用越来越多，这些类型的手术体位变得越来越频繁。目前评估神经肌肉阻断的技术在这些类型的外科手术中不起作用。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

The broader impact/commercial potential of this I-Corps project is the development of a Train-of-Four (TOF) device to provide a method of quantitatively monitoring neuromuscular blockade in patients undergoing surgery. Neuromuscular blocking agents (NMBAs) are used extensively to temporarily paralyze patients during surgery. Current methods of measurement have a risk of postoperative residual neuromuscular blockade, where NMBAs remaining in the body after surgery. This postoperative problem can cause muscle weakness and critical respiratory episodes. The current standard Train-of-Four (TOF) monitoring method is qualitative, and anesthesiologists must depend on their eyesight and experience to judge the correct dosing of patients. The proposed device produces a quantitative output, TOF data, to help anesthesiologists gauge how much neuromuscular blockade to administer to each patient and when to reverse its effects. By ensuring complete neuromuscular recovery, the proposed device minimizes respiratory complications and the unpleasant symptom of muscle weakness caused by residual neuromuscular blocking agents in the body post-surgery. The device may prevent unwanted post-operative stress, while potentially saving money for hospitals.This I-Corps project is based on the development of a mechanomyography device that uses medical grade balloons for converting patient response to Train-of-Four (TOF) data. In the device, the use of a peripheral nerve stimulator on the ulnar nerve causes thumb twitches that apply pressure on a balloon. These pressure fluctuations are picked up by a sensor and converted into TOF data to accurately measure the level of neuromuscular blockade in the body by using pressure as the physical analog of muscle numbness and converting it into an electrical signal. The proposed device utilizes mechanomyography, which is thought to be the gold standard and most accurate technology for monitoring neuromuscular blockade, since it directly measures the motion generated as the muscle responds to the ulnar nerve stimulation. There is currently no mechanomyography device on the market to monitor neuromuscular blockade. Furthermore, the proposed device assesses the TOF count and TOF ratio even in positions where the thumb’s movement is restricted; for example, when the hands are tucked beside the body. These types of surgical positions are becoming more frequent with increased use of laparoscopic surgeries. The current technologies in assessing neuromuscular blockade are not functional in these types of surgical positions.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.