"The Bromage Score: A Simple Tool for Assessing Muscle Relaxation During Anesthesia"
If you have recently had surgery or are planning to have surgery soon, your doctor may use the Bromage score to assess your level of anesthesia. The Bromage score is a simple and effective tool used by anesthesiologists to determine the level of muscle relaxation in a patient undergoing surgery.
Here's a step-by-step guide on how to assess the Bromage score:
Step 1: Understand the Bromage score
The Bromage score is a numerical scale that ranges from 0 to 3, with 0 representing no muscle paralysis and 3 representing complete paralysis. The score is determined by assessing the level of muscle relaxation in the patient's lower limbs. Anesthesiologists use the score to determine the level of anesthesia needed to perform a surgical procedure safely.
Step 2: Evaluate the patient's lower limbs
To assess the Bromage score, the anesthesiologist will evaluate the patient's lower limbs for muscle relaxation. The patient should be in a supine position, and the anesthesiologist should gently lift each leg and assess the degree of muscle relaxation.
Step 3: Assign a score based on muscle relaxation
Using the Bromage scale, the anesthesiologist will assign a score based on the level of muscle relaxation observed. Here's a breakdown of what each score represents: (see photo)
Bromage score 0: No muscle paralysis. The patient has full flexion of knees and feet.
Bromage score 1: Partial or Mild muscle paralysis. The patient is just able to move knees.
Bromage score 2: Almost complete or Moderate muscle paralysis. The patient is able to move feet only.
Bromage score 3: Complete muscle paralysis. The patient cannot move their feet, lift their legs, or move their knee joints.
0 = Observe hourly for first 4 hours, then every 4 hours
1 = Contact pain service/physician/anesthesiologist for patient assessment and order review
2 = Stop infusion and contact pain service/physician/anesthesiologist
3 = Stop infusion and contact pain service/physician/anesthesiologist
Step 4: Use the score to adjust anesthesia
Once the Bromage score has been determined, the anesthesiologist can adjust the level of anesthesia accordingly. For example, if a patient has a Bromage score of 2, the anesthesiologist may need to administer more anesthesia to achieve complete muscle relaxation.
It is important to assess motor block:
to determine the amount of motor function
to prevent pressure areas
to ensure the patient is safe to ambulate (if allowed)
to detect the onset of complications eg epidural haematoma or abscess
Assess motor block 4 hourly and at the following times:
In the recovery room following surgery
On return to the ward/unit from the operating suite
At commencement of each nursing shift
Prior to ambulation
1 hour after a bolus or increase in the infusion rate
Contact the MD or Stop the epidural:
major changes in motor function (particularly any sudden change)
almost complete or complete motor block (Bromage score 2 - 3)
reduced hand or finger motor function with a thoracic epidural
In conclusion, the Bromage score is a simple and effective tool that anesthesiologists use to assess muscle relaxation in patients undergoing surgery. By following these steps, you can better understand how the score is assessed and how it can be used to ensure safe and effective anesthesia during surgical procedures.
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