RGB Medical NMT (TOF) Monitor – NMTCuff® Technology
RGB Medical NMT (TOF) Monitor – NMTCuff® Technology
The RGB Medical NMT monitor quantitatively measures neuromuscular transmission during general anesthesia and monitors non-invasive blood pressure (NIBP) with the same cuff. Measurement is performed with the specially designed NMTCuff®; application is as easy as putting on a standard blood pressure cuff. The device is manufactured by RGB Medical Devices in Madrid, Spain; the technology received US FDA 510(k) clearance under the name TOF-Cuff (K181894). Prizma-Med Sağlık Hizmetleri is the exclusive Türkiye distributor for RGB Medical.
This page is intended for healthcare professionals. Please refer to the product's instructions for use for detailed information.
Why quantitative neuromuscular monitoring?
The effect of neuromuscular blocking agents may persist after surgery. This condition, called postoperative residual curarization (PORC), puts the patient at risk by causing weakness of the respiratory and swallowing muscles. Assessment by clinical observation cannot reliably rule out residual block. For this reason, the APSF, ASA and ESAIC recommend the use of quantitative neuromuscular monitoring wherever anesthesia is administered. The goal is to objectively demonstrate a TOF ratio of 0.9 or higher before extubation.
How does NMTCuff® work? (Compressomyography – CMG)
Stimulation electrodes built into the NMTCuff® stimulate the muscle; the muscle response is measured pneumatically as a pressure change inside the cuff. Stimulation and measurement are combined in the same sensor. Because the connection between the device and the patient is pneumatic rather than electrical, the measurement is designed to be unaffected by electrical noise in the operating room.
Key features
- Dual function: Relaxometry (TOF) and NIBP in a single cuff
- Integrated stimulation electrodes: No separate electrodes need to be placed
- Pneumatic measurement: No electrical connection between the device and the patient
- Flexible placement: Can be applied to the arm, forearm, wrist, leg or thigh
- Secure connection: Does not easily become detached if the cable is pulled
Why NMTCuff®?
- Easy setup: The cuff is applied like a blood pressure cuff; no additional steps for attaching electrodes, fixing sensors or calibration are required. This makes it easier for quantitative monitoring to become routine.
- The arm does not need to be free: Unlike acceleromyography (AMG), the thumb does not need to move freely; measurement is possible even when the arms are under drapes or tucked at the patient's side.
- One cuff, two parameters: NIBP and neuromuscular monitoring are performed with the same cuff, reducing additional cables and sensors on the patient.
- Pneumatic measurement: Because the measurement signal is transmitted pneumatically, it is intended to be less affected than electromyographic (EMG) methods by electrical sources such as electrocautery.
How it differs from alternatives
Quantitative neuromuscular monitors fall into three main groups by measurement method: Acceleromyography (AMG) measures the acceleration of thumb movement and requires the thumb to move freely and often an initial calibration. Electromyography (EMG) measures the electrical response of the adductor pollicis muscle; it does not depend on hand movement but requires skin electrodes. Compressomyography (CMG – NMTCuff®) measures the muscle response in the upper arm as a pressure change inside the cuff; ease of setup and combined use with NIBP are the main distinguishing features of this method.
Important to know
TOF values measured with different methods and from different muscles are not interchangeable. Independent comparative studies have reported differences between NMTCuff® measurements and EMG measurements from the adductor pollicis muscle; in particular, recovery may appear earlier with compressomyography than with EMG (Honing et al., J Clin Anesth 2022; Markle et al., Anaesthesiol Intensive Ther 2020). The ASA 2023 guideline recommends the adductor pollicis muscle for neuromuscular monitoring. The extubation decision should be made with knowledge of these characteristics of the method used and together with clinical assessment.
Areas of use
Adult patients receiving general anesthesia and neuromuscular blocking agents; operating rooms and recovery units. The device is intended for use by trained healthcare professionals in healthcare institutions.
Demo and training requests
For clinical evaluation, a demo device and product information: +90 342 360 64 50 · info@prizmamed.com.tr
References: RGB Medical Devices product information; US FDA 510(k) database, K181894; Honing GHM et al. J Clin Anesth 2022; Markle A et al. Anaesthesiol Intensive Ther 2020;52(3):183–188; Thilen SR et al. ASA Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade, Anesthesiology 2023.
More information: For the manufacturer and origin, technology, guideline recommendations and scientific studies, see our RGB Medical NMT (TOF) Monitor Detailed Product Guide.