The Correlation Between the Frontal Electromyography Parameter in Patient State Index (PSI) Monitor and Train of Four
Condition: Muscle Relaxation
Study type: Observational [Patient Registry]

Summary: 
      The Train Of Four (TOF) Monitor will be placed on ulnar nerve on right wrist of the patients
      who has surgery under general anaesthesia. This is for stimulation of adductor pollicis
      muscle. Sedline (Masimo Electromyography(EMG) and Patient State Index(PSI)) Monitor will be
      placed on the frontal area of head. After the induction of general anaesthesia the
      investigators will wait for disappearance of eyelash reflex. TOF monitor will be calibrated
      and muscle relaxant will be applied. After TOF is %0 and disappearance of thumb movement the
      patient will be intubated. After surgery the investigators will apply muscle relaxant
      reversal drugs. Then the investigators will record PSI and EMG parameters when TOF is %0,
      %25, %50,%75,%90. When TOF is %90 the investigators will extubate the patient. The
      investigators will record PSI and EMG parameters after 5 minutes.
    

Detailed description: 
      The study is planned prospective and observational. The study started after approval of
      Erzincan Binali Yıldırım University Ethics Committee and taking written approval of patients.
      The study includes 84 patients who has surgery continues more then 1 hour, who is between
      ages 18-65, who is ASA I,II and III. The patients who has allergical reactions of the drugs
      used, neurological or neuromuscular diseases,the patients who use drugs effecting the
      neuromuscular junction, pregnant patients, electrolyte disregulations, major organ failures,
      liver failure, kidney failure, obese and cachectic patients are excluded from the study.

      All patients will be informed and signed written approval 1 day before the surgery. Patients
      will be taken to the operating room, venous catheter will be applied on antecubital area. 3
      channel EKG , SpO2 Monitor and noninvasive blood pressure monitorisation will be applied. The
      patients will be taken 2-4 litres of O2 with nasal cannula .The Train Of Four (TOF) Monitor
      will be placed on ulnar nerve on right wrist of the patients who has surgery under general
      anaesthesia. This is for stimulation of adductor pollicis muscle. Sedline (Masimo
      Electromyography(EMG) and Patient State Index(PSI)) Monitor will be placed on the frontal
      area of head. After the induction of general anaesthesia the investigators will wait for
      disappearance of eyelash reflex. TOF monitor will be calibrated and muscle relaxant will be
      applied. After TOF is %0 and disappearance of thumb movement the patient will be intubated.
      After surgery the investigators will apply muscle relaxant reversal drugs. PSI and EMG
      parameters will be recorded when TOF is %0, %25, %50,%75,%90. When TOF is %90 the
      investigators will extubate the patient. PSI and EMG parameters will be recorded after 5
      minutes. The patient will be taken to the PACU room. On 5,10,30 minutes after surgery, the
      investigators will record aldrete score of patients.
    

Intervention name(s): Masimo Sedline Monitor Patient State Index
Intervention type(s): Device
Intervention description(s): Masimo Sedline Monitor shows frontal electromyography and patient state index, Train of four monitor shows muscle strength on adductor pollicis muscle
Other intervention name(s): Train Of Four
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        the patients wha has surgery continues more then 1 hour