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1.

001-es BibID:BIBFORM122916
035-os BibID:(scopus)85195642584
Első szerző:Epstein, Richard H.
Cím:Area under the curve and amplitude of the compound motor action potential are clinically interchangeable quantitative measures of neuromuscular block : a method comparison study / Epstein Richard H., Nemes Réka, Renew Johnathan R., Brull Sorin J.
Dátum:2024
ISSN:2772-6096
Megjegyzések:Background: Current guidelines recommend quantitative neuromuscular block monitoring during neuromuscular blocking agent administration. Monitors using surface electromyography (EMG) determine compound motor action potential (cMAP) amplitude or area under the curve (AUC). Rigorous evaluation of the interchangeability of these methods is lacking but necessary for clinical and research assurance that EMG interpretations of the depth of neuromuscular block are not affected by the methodology. Methods: Digitised EMG waveforms were studied from 48 patients given rocuronium during two published studies. The EMG amplitudes and AUCs were calculated pairwise from all cMAPs classified as valid by visual inspection. Ratios of the first twitch (T1) to the control T1 before administration of rocuronium (T1c) and train-of-four ratios (TOFRs) were compared using repeated measures Bland?Altman analysis. Results: Among the 2419 paired T1/T1c differences where the average T1/T1c was ?0.2, eight (0.33%) were outside prespecified clinical limits of agreement (?0.148 to 0.164). Among the 1781 paired TOFR differences where the average TOFR was ?0.8, 70 (3.93%) were outside the prespecified clinical limits of agreement ((?0.109 to 0.134). Among all 7286 T1/T1c paired differences, the mean bias was 0.32 (95% confidence interval 0.202?0.043), and among all 5559 paired TOFR differences, the mean bias was 0.011 (95% confidence interval 0.0050?0.017). Among paired T1/T1c and TOFR differences, Lin's concordance correlation coefficients were 0.98 and 0.995, respectively. Repeatability coefficients for T1/T1c and TOFR were <0.08, with no differences between methods. Conclusions: Quantitative assessment neuromuscular block depth is clinically interchangeable when calculated using cMAP amplitude or the AUC. ? 2024 The Authors
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
action potentials
electromyography
monitoring
neuromuscular block
signal processing
Megjelenés:BJA Open. - 11 (2024), p. 1-10.-
További szerzők:Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Renew, J. Ross Brull, Sorin J.
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2.

001-es BibID:BIBFORM121179
035-os BibID:(Scopus)85188214468
Első szerző:Epstein, Richard H.
Cím:Validation of a convolutional neural network that reliably identifies electromyographic compound motor action potentials following train-of-four stimulation : an algorithm development experimental study - Reply to: Br J Anaesth Open 2024:100264 / Richard H. Epstein, Olivia F. Perez, Ira S. Hofer, J. Ross Renew, Reka Nemes, Sorin J. Brull
Dátum:2024
ISSN:2772-6096
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
electromyography
machine learning
neural network
neuromuscular block
train-of-four
Megjelenés:BJA Open. - 9 (2024), p. 1-8. -
További szerzők:Perez, Olivia F. Hofer, Ira S. Renew, J. Ross Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Brull, Sorin J.
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3.

001-es BibID:BIBFORM119600
035-os BibID:(Scopus)85186398760
Első szerző:Epstein, Richard H.
Cím:Corrigendum to "Validation of a convolutional neural network that reliably identifies electromyographic compound motor action potentials following train-of-four stimulation: an algorithm development experimental study" [BJA Open 8 (2023) 100236] / Richard H. Epstein, Olivia F. Perez, Ira S. Hofer, J. Ross Renew, Reka Nemes, Sorin J. Brull
Dátum:2024
ISSN:2772-6096
Megjegyzések:The authors regret errors in the above article regarding the use of the term ♭convolutional neural network'. The title should have read ♭Validation of a fully connected neural network that reliably identifies electromyographic compound motor action potentials following train-of-four stimulation: an algorithm development experimental study.' Also, ♭fully connected neural network' should replace ♭convolutional neural network' and ♭FCNN' should replace ♭CNN' in the abstract and the body of the article, respectively. None of the results or conclusions are affected by these corrections. The authors apologise for any inconvenience caused.
Tárgyszavak:Orvostudományok Klinikai orvostudományok hozzászólás
folyóiratcikk
Megjelenés:BJA Open. - 9 (2024), p. 1. -
További szerzők:Perez, Olivia F. Hofer, Ira S. Renew, J. Ross Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Brull, Sorin J.
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4.

001-es BibID:BIBFORM117741
035-os BibID:(cikkazonosító)100236 (Scopus)85181231741
Első szerző:Epstein, Richard H.
Cím:Validation of a convolutional neural network that reliably identifies electromyographic compound motor action potentials following train-of-four stimulation : an algorithm development experimental study / Richard H. Epstein, Olivia F. Perez, Ira S. Hofer, J. Ross Renew, Reka Nemes, Sorin J. Brull
Dátum:2023
ISSN:2772-6096
Megjegyzések:Background: International guidelines recommend quantitative neuromuscular monitoring when administering neuromuscular blocking agents. The train-of-four count is important for determining the depth of block and appropriate reversal agents and doses. However, identifying valid compound motor action potentials (cMAPs) during surgery can be challenging because of low-amplitude signals and an inability to observe motor responses. A convolutional neural network (CNN) to classify cMAPs as valid or not might improve the accuracy of such determinations. Methods: We modified a high-accuracy CNN originally developed to identify handwritten numbers. For training, we used digitised electromyograph waveforms (TetraGraph) from a previous study of 29 patients and tuned the model parameters using leave-one-out cross-validation. External validation used a dataset of 19 patients from another study with the same neuromuscular block monitor but with different patient, surgical, and protocol characteristics. All patients underwent ulnar nerve stimulation at the wrist and the surface electromyogram was recorded from the adductor pollicis muscle. Results: The tuned CNN performed highly on the validation dataset, with an accuracy of 0.9997 (99% confidence interval 0.9994?0.9999) and F1 score=0.9998. Performance was equally good for classifying the four individual responses in the train-of-four sequence. The calibration plot showed excellent agreement between the predicted probabilities and the actual prevalence of valid cMAPs. Ten-fold cross-validation using all data showed similar high performance. Conclusions: The CNN distinguished valid cMAPs from artifacts after ulnar nerve stimulation at the wrist with >99.5% accuracy. Incorporation of such a process within quantitative electromyographic neuromuscular block monitors is feasible.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
electromyography
machine learning
neural network
neuromuscular block
train-of-four
Megjelenés:BJA Open. - 8 (2023), p. 1-9. -
További szerzők:Perez, Olivia F. Hofer, Ira S. Renew, J. Ross Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Brull, Sorin J.
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5.

001-es BibID:BIBFORM112910
035-os BibID:(wos)001011827700001 (scopus)85162693630
Első szerző:Fuchs-Buder, Thomas
Cím:Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents : The 2023 Geneva revision / Fuchs-Buder Thomas, Brull Sorin J., Fagerlund Malin Jonsson, Renew Ross J., Cammu Guy, Murphy Glenn S., Warlé Michiel, Vested Matias, Fülesdi Béla, Nemes Reka, Columb Malachy O., Damian Daniela, Davis Peter J., Iwasaki Haijme, Eriksson Lars I.
Dátum:2023
ISSN:0001-5172
Megjegyzések:The set of guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents was developed following an international consensus conference in Copenhagen in 1996 (Viby-Mogensen et al., Acta Anaesthesiol Scand 1996, 40, 59?74); the guidelines were later revised and updated following the second consensus conference in Stockholm in 2005 (Fuchs-Buder et al., Acta Anaesthesiol Scand 2007, 51, 789?808). In view of new devices and further development of monitoring technologies that emerged since then, (e.g., electromyography, three-dimensional acceleromyography, kinemyography) as well as novel compounds (e.g., sugammadex) a review and update of these recommendations became necessary. The intent of these revised guidelines is to continue to help clinical researchers to conduct high-quality work and advance the field by enhancing the standards, consistency, and comparability of clinical studies. There is growing awareness of the importance of consensus-based reporting standards in clinical trials and observational studies. Such global initiatives are necessary in order to minimize heterogeneous and inadequate data reporting and to improve clarity and comparability between different studies and study cohorts. Variations in definitions of endpoints or outcome variables can introduce confusion and difficulties in interpretation of data, but more importantly, it may preclude building of an adequate body of evidence to achieve reliable conclusions and recommendations. Clinical research in neuromuscular pharmacology and physiology is no exception.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
depth of neuromuscular blockade
neuromuscular monitoring
neuromuscular research
pharmacodynamics
postoperative pulmonary complications
time course of neuromuscular blockade
Megjelenés:Acta Anaesthesiologica Scandinavica. - 67 : 8 (2023), p. 994-1017. -
További szerzők:Brull, Sorin J. Fagerlund, Malin Jonsson Renew, J. Ross Cammu, Guy Murphy, Glenn S. Warlé, Michiel Vested, Matias Fülesdi Béla (1961-) (aneszteziológus) Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Columb, Malachy O. Damian, Daniela Davis, Peter J. Iwasaki, Haijme Eriksson, Lars I.
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6.

001-es BibID:BIBFORM094422
Első szerző:Iwasaki, Hiroyuki
Cím:Quantitative Neuromuscular Monitoring : current Devices, New Technological Advances, and Use in Clinical Practice / Iwasaki H., Nemes R., Brull S. J., Renew J. R.
Dátum:2018
Megjegyzések:Purpose of Review The purpose of this review is to summarize various quantitative neuromuscular monitoring modalities and describe strategies to implement them into routine practice. We will contrast these objective modalities with unreliable clinical tests and subjective techniques that expose patients to unnecessary risk associated with postoperative residual weakness. Recent Findings As major specialty societies publish guidelines and consensus statements urging anesthesiologists to utilize quantitative monitors, clinicians must familiarize themselves with this equipment. Furthermore, new monitors are emerging as the industry tries to address the need for user-friendly, reliable monitors. Summary Clinical assessment is an unacceptable technique to guide neuromuscular blockade management in patients receiving neuromuscular blocking agents. The use of a peripheral nerve stimulator can provide some information regarding the level of neuromuscular blockade in patients; however, it cannot reliably confirm adequate recovery. The use of objective, quantitative monitoring is an essential practice that helps guide the administration of neuromuscular blocking agents and excludes deleterious postoperative residual weakness.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Current Anesthesiology Reports. - 8 : 1 (2018), p. 1-11. -
További szerzők:Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Brull, Sorin J. Renew, J. Ross
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7.

001-es BibID:BIBFORM109405
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Reversal Aagents of neuromuscular block / Réka Nemes, J. Ross Renew, Sorin J. Brull
Dátum:2020
ISBN:978-0-323-56702-2
Tárgyszavak:Orvostudományok Klinikai orvostudományok könyvfejezet
könyvrészlet
Megjelenés:Faust's Anesthesiology Review, 5th Edition / ed. Terrence L. Tretman. - p. 179-183. -
További szerzők:Renew, J. Ross Sorin, J. Brull
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8.

001-es BibID:BIBFORM096675
035-os BibID:(WoS)000695249600011 (Scopus)85115605217
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Ipsilateral and Simultaneous Comparison of Responses from Acceleromyography- and Electromyography-based Neuromuscular Monitors / Nemes Réka, Lengyel Szabolcs, Nagy György, Hampton David R., Gray Martyn, Renew J. Ross, Tassonyi Edömér, Fülesdi Béla, Brull Sorin J.
Dátum:2021
ISSN:0003-3022
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Anesthesiology. - 135 : 4 (2021), p. 597-611. -
További szerzők:Lengyel Szabolcs (1971-) (biológus) Nagy György (1986-) (aneszteziológus, intenzív terápiás szakorvos) Hampton, David R. Gray, Martyn Renew, J. Ross Tassonyi Edömér (1940-2022) (aneszteziológus) Fülesdi Béla (1961-) (aneszteziológus) Brull, Sorin J.
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9.

001-es BibID:BIBFORM094452
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Clinical Practice Guideline for the Management of Neuromuscular Blockade : what Are the Recommendations in the USA and Other Countries? / Nemes R., Renew J. R.
Dátum:2020
Megjegyzések:Purpose of Review This review addresses various societal guidelines, standards, and consensus statements regarding optimal neuromuscular blockade management. We discuss the historical evolution of neuromuscular management as a means of identifying possible future trends. Recent Findings While a recent international panel of experts has called for abandoning clinical assessment and subjective evaluation using a peripheral nerve stimulator in favor of adopting quantitative monitoring, few anesthesia societies mandate similar practices at the moment. Summary The current status of neuromuscular monitoring in the world is still variable and unsatisfactory. Nevertheless, a positive trend can be observed in the anesthesia community to adopt and learn this neglected technique. The development of user-friendly monitoring devices should also help this process, but anesthesia national societies still need to do a lot to replace outdated and substandard practices.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Current Anesthesiology Reports. - 10 (2020), p. 90-98. -
További szerzők:Renew, J. Ross
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10.

001-es BibID:BIBFORM094407
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Physiology of neuromuscular transmission / Réka Nemes, J. Ross Renew, Sorin J. Brull
Dátum:2020
ISBN:978-0-323-56702-2
Tárgyszavak:Orvostudományok Klinikai orvostudományok könyvfejezet
könyvrészlet
Megjelenés:Faust's Anesthesiology Review, 5th Edition / Ed. Terrence L. Trentman, Brantley D. Gaitan, Bhargavi Gali, Rebecca L. Johnson, Jeffrey T. Mueller, Steven H. Rose, Toby N. Weingarten. - p. 91-94. -
További szerzők:Renew, J. Ross Brull, Sorin J.
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11.

001-es BibID:BIBFORM094408
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Reversal Agents of neuromuscular block / Réka Nemes, J. Ross Renew, Sorin J. Brull
Dátum:2020
ISBN:978-0-323-56702-2
Tárgyszavak:Orvostudományok Klinikai orvostudományok könyvfejezet
könyvrészlet
Megjelenés:Faust's Anesthesiology Review, 5th Edition / Ed. Terrence L. Trentman, Brantley D. Gaitan, Bhargavi Gali, Rebecca L. Johnson, Jeffrey T. Mueller, Steven H. Rose, Toby N. Weingarten. - p. 179-183. -
További szerzők:Renew, J. Ross Brull, Sorin J.
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12.

001-es BibID:BIBFORM087868
035-os BibID:(WoS)000529444900043 (Scopus)85082146494
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Awake Volunteer Pain Scores During Neuromuscular Monitoring / Réka Nemes, György Nagy, Glenn S. Murphy, Ilana I. Logvinov, Béla Fülesdi, J. Ross Renew
Dátum:2020
ISSN:0003-2999
Megjegyzések:BACKGROUND: There is a need for easy to use, reliable neuromuscular monitors (NMMs). This multicenter, prospective, unblinded study compared the discomfort associated with neurostimulation in unmedicated healthy volunteers when using the new electromyography (EMG)-based TetraGraph and acceleromyography (AMG)-based TOF-Watch NMMs. The secondary aim was to compare the repeatability of the train-of-four (TOF) ratios (TOFRs) obtained with the 2 devices. METHODS: The TOF measurements of 135 volunteers from 3 university hospitals were analyzed (age: 38.3 ? 12 years [mean ? standard deviation [SD]]; male/female ratio = 63:72). The left or right ulnar nerve was stimulated at the wrist in TOF mode with 20, 30, 40, and 50 mA stimulating current intensities with both devices in random order. The TOF-Watch used standard electrocardiography (ECG) electrodes (Red Dot; 3M Health Care) for nerve stimulation. The stimulating surface area of 1 ECG electrode is 113 mm2. The piezoelectric probe was attached to the thumb, and a hand adapter was used to ensure consistency of AMG measurements. The TetraGraph uses proprietary surface strip electrodes for nerve stimulation and muscle action potential recording, whose stimulating surface area is roughly twice as big as that of standard ECG electrodes (228.5 mm2). The volunteers were asked to rate the discomfort associated with neurostimulation on a 0?10 verbal numerical rating scale (VNRS) score anchored with 0 (no pain) and 10 (worst pain ever experienced). A linear mixed-effects model was used to evaluate the difference in VNRS scores between devices. P <.05 was accepted as the level of significance. RESULTS: In the linear mixed-effects model, there were no differences in VNRS scores between devices at any of the stimulating current intensities, P = .38. The median (range) VNRS scores obtained with TOF-Watch and TetraGraph devices were 2 (0?7) vs 2 (0?8) at 20 mA, 3 (1?9) vs 3 (1?9) at 30 mA, 5 (1?10) vs 5 (1?10) at 40 mA, and 5 (1?10) vs 6 (1?10) at 50 mA stimulating current intensities. The mean of the 1469 TOFRs obtained with TetraGraph was 100.43% ? 7.74% (standard error = 0.2%). Due to technical difficulties, the repeatability of the TOFRs could not be determined. CONCLUSIONS: Despite the different size and design of the stimulating electrodes, the 2 NMMs caused the same level of discomfort in unmedicated healthy volunteers.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Anesthesia and Analgesia. - 130 : 4 (2020), p. 941-948. -
További szerzők:Nagy György (1986-) (aneszteziológus, intenzív terápiás szakorvos) Murphy, Glenn S. Logvinov, Ilana I. Fülesdi Béla (1961-) (aneszteziológus) Renew, J. Ross
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