Document Detail

Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii.
MedLine Citation:
PMID:  17561516     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Because the intensity of neuromuscular block at the diaphragm (DIA) is indirectly assessed, the electromyographic measurements of the DIA (DIA(EMG)) from surface electrodes were related to information provided by visual estimation of neuromuscular transmission at the adductor pollicis (AP) and the corrugator supercilii (CSC) during recovery from vecuronium block. METHODS: Twelve adult patients were studied during balanced anaesthesia. After induction of anaesthesia and tracheal intubation without neuromuscular blocking agent, supramaximal stimulations were applied to phrenic, ulnar and facial nerves. During recovery from vecuronium 0.1 mg kg(-1) an independent observer blinded to DIA(EMG) counted visually detectable train-of-four (TOF) at CSC (TOF(CSC)) and post-tetanic AP (PTC(AP)) responses. Times to recovery of PTC(AP) = 1, <or=5, <10 and >10, and TOF(CSC) = 1-4 responses were related to DIA(EMG). Values are means (sd). RESULTS: Reappearance of the first response to PTC(AP) occurred significantly (P < 0.05) earlier and for a lower recovery of DIA(EMG) than that of TOF(CSC) [24 (8) min vs 33 (9) min, and 10 (10)% vs 25 (8)%, respectively]. With PTC(AP) <or= 5 response, DIA(EMG) recovery was 21 (11)%. Recovery of TOF(CSC) = 1 and 2 coincided with DIA(EMG) recovery of 25 (8)% and 47 (9)%, respectively. CONCLUSIONS: PTC(AP) may better reflect early recovery of vecuronium-induced DIA paralysis than TOF(CSC). The findings suggested that PTC(AP) <or= 5 warranted deep neuromuscular block of the DIA.
G Dhonneur; K Kirov; C Motamed; R Amathieu; W Kamoun; V Slavov; S-K Ndoko
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-06-07
Journal Detail:
Title:  British journal of anaesthesia     Volume:  99     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-17     Completed Date:  2007-10-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  376-9     Citation Subset:  IM    
Anaesthesia and Intensive Care Department, Jean Verdier University Hospital of Paris, 93143 Bondy Cedex, France.
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MeSH Terms
Anesthesia Recovery Period*
Diaphragm / drug effects*,  physiology
Electric Stimulation / methods
Electromyography / drug effects
Facial Muscles / drug effects,  physiology
Middle Aged
Monitoring, Physiologic / methods
Muscle, Skeletal / drug effects*,  physiology
Neuromuscular Blockade
Neuromuscular Junction / drug effects
Neuromuscular Nondepolarizing Agents / pharmacology*
Postoperative Care / methods
Single-Blind Method
Vecuronium Bromide / pharmacology*
Reg. No./Substance:
0/Neuromuscular Nondepolarizing Agents; 50700-72-6/Vecuronium Bromide

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