Document Detail

Normalization of acceleromyographic train-of-four ratio by baseline value for detecting residual neuromuscular block.
MedLine Citation:
PMID:  16299046     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: This study was designed to recognize the importance of normalizing postoperative acceleromyographic train-of-four (TOF) ratio by the baseline TOF value obtained before neuromuscular block for ensuring adequate recovery of neuromuscular function. METHODS: In 120 patients, TOF responses of the adductor pollicis to the ulnar nerve stimulation were monitored by acceleromyography (AMG) during anaesthesia using propofol, fentanyl and nitrous oxide. Control TOF stimuli were administered for 30 min. A TOF ratio measured at the end of control stimulation was regarded as a baseline value. Neuromuscular block was induced with vecuronium 0.1 mg kg(-1) and was allowed to recover spontaneously. Duration to a TOF ratio of 0.9 as calculated by AMG (DUR-raw 0.9) was compared with that of 0.9 as corrected by the baseline TOF ratio (i.e. 0.9 x baseline TOF ratio; DUR-real 0.9). RESULTS: Baseline TOF ratios ranged from 0.95 to 1.47. The average TOF ratios observed every 5 min were constant throughout control stimulation from at time zero mean (SD) [range]; 1.11 (0.09) [0.94-1.42] to at 30 min 1.13 (0.11) [0.95-1.47]. The DUR-real 0.9 was 91.0 (18.0) [51.3-131.0] min and was significantly longer than the DUR-raw 0.9 (81.2 (16.3) [41.3-123.0] min). CONCLUSIONS: Baseline TOF ratios measured by AMG are usually more than 1.0 and vary widely among patients. Therefore a TOF ratio of 0.9 displayed postoperatively on AMG does not always represent adequate recovery of neuromuscular function and should be normalized by baseline value to reliably detect residual paralysis.
T Suzuki; N Fukano; O Kitajima; S Saeki; S Ogawa
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Publication Detail:
Type:  Journal Article     Date:  2005-11-18
Journal Detail:
Title:  British journal of anaesthesia     Volume:  96     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-16     Completed Date:  2006-01-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  44-7     Citation Subset:  IM    
Department of Anesthesiology, Surugadai Nihon University Hospital, 1-8-13, Kanda-Surugadai, Chiyoda-Ku, Tokyo 101-8309, Japan.
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MeSH Terms
Anesthesia Recovery Period
Anesthesia, General
Electric Stimulation / methods
Middle Aged
Monitoring, Intraoperative / methods
Myography / methods
Neuromuscular Blockade / methods*
Neuromuscular Junction / drug effects*,  physiology
Neuromuscular Nondepolarizing Agents / pharmacology*
Postoperative Care / methods
Vecuronium Bromide / pharmacology*
Reg. No./Substance:
0/Neuromuscular Nondepolarizing Agents; 50700-72-6/Vecuronium Bromide

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