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Results for “Neuromuscular Blockade”

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PubMed1997

Evaluation of residual neuromuscular blockade using modified double burst stimulation.

BACKGROUND: To assess the degree of residual neuromuscular blockade, double burst stimulation (DBS) is commonly applied in the clinical setting. However, fades in response to DBS3,3 can rarely be identified manually when train-of-four (TOF) ratios are > or = 0.70, and, in contrast, fades in response to DBS3,2 are felt manually in an undesirably high proportion of cases, even at TOF ratios greater than 0.7. We investigated whether a new monitoring method, modified DBS, would be useful to determine an adequate degree of recovery from neuromuscular blockade. For modified DBS, two burst stimuli were applied at an interval of 750 ms. The first stimulation in the modified DBS consisted of two stimuli of 0.3 ms duration at 50 Hz and the second of two stimuli of 0.2 ms duration at 50 Hz. METHODS: Forty-five adult patients undergoing elective nitrous oxide-oxygen-isoflurane anesthesia were randomly divided into one of three groups: DBS3,3 group (n = 15), DBS3,2 group (n = 15), or modified DBS group (n = 15). During recovery from vecuronium-induced neuromuscular blockade, on both forearms, DBS3,3, DBS3,2, and modified DBS were delivered in the DBS3,3 group, DBS3,2 group, and modified DBS group, respectively. One hand and forearm (fixed arm) were immobilized to quantify the degree of neuromuscular blockade mechanically, and the contralateral arm (free arm) was unrestrained. An observer determined tactiley on the free arm the presence or absence of fade in response to the three DBS patterns. RESULTS: Probabilities of detection of fade in response to the DBS3,3 were 67% (TOF ratio of 0.51-0.60), 40% (0.61-0.70), 19% (0.71-0.80), 5% (0.81-0.90), and 0% (0.91-1.00). Those to the DBS3,2 were 95% (0.51-0.60), 93% (0.61-0.70), 83% (0.71-0.80), 65% (0.81-0.90), and 38% (0.91-1.00). Those to modified DBS were 90% (0.51-0.60), 86% (0.61-0.70), 65% (0.71-0.80), 25% (0.81-0.90), and 3% (0.91-1.00). Those modified DBS was more sensitive in diagnosing residual neuromuscular blockade than DBS3,3 at the TOF ratio of 0.51-0.90, but was less sensitive than DBS3,2 at the TOF ratio of 0.81-1.00 (P < 0.05). CONCLUSION: Our results indicate that the modified DBS may be a useful stimulation pattern to diagnose the adequacy of recovery from neuromuscular blockade.

Adult↗

PubMed1987

Antagonism of vecuronium-induced neuromuscular blockade with edrophonium or neostigmine.

Antagonism of vecuronium-induced neuromuscular blockade was attempted, at varying degrees of spontaneous recovery, with edrophonium 0.5 mg kg-1 or neostigmine 0.05 mg kg-1 in two groups of 20 patients. Neuromuscular blockade was monitored using a train-of-four (TOF) stimulation. Adequate antagonism of neuromuscular blockade, defined as a sustained TOF ratio of 0.7 or more, was attained in all 20 patients given neostigmine and in 13 out of 20 given edrophonium. Five of the remaining seven patients given edrophonium had shown three or less responses to TOF stimulation before antagonism. While the time to onset of the action of edrophonium (22 s) was not significantly shorter than neostigmine (26 s), the time taken to attain a TOF ratio of 0.7 was significantly shorter with edrophonium (67 s compared with 194 s with neostigmine). It is concluded that edrophonium 0.5 mg kg-1 does not consistently antagonize vecuronium-induced neuromuscular blockade, particularly if there are three or less responses to a TOF stimulation present before antagonism.

Adult↗

PubMedDate not supplied

The effect of ondansetron on atracurium-induced neuromuscular blockade.

STUDY OBJECTIVE: To determine whether treatment with ondansetron, a new antiemetic drug, affects nondepolarizing neuromuscular blockade. DESIGN: Randomized, double-blind, prospective study. SETTING: Operating room at a university medical center. PATIENTS: 30 ASA physical status I and II patients scheduled for elective surgery. INTERVENTIONS: After the induction of anesthesia with midazolam 2 to 4 mg/kg, sodium thiopental 6 to 8 mg/kg, and fentanyl 4 to 8 micrograms/kg, the ulnar nerve was stimulated at the wrist through subcutaneous needle electrodes at a frequency of 0.15 Hz. The response to stimulation was measured and recorded with a force-displacement transducer applied to the thumb. Patients were randomized to one of three treatment groups. A steady baseline to ulnar nerve stimulation with nitrous oxide-oxygen-opioid-thiopental anesthesia was established. The first study group (Group 1) received a placebo, the second group (Group 2) received 8 mg of ondansetron, and the third group (Group 3) received 16 mg of ondansetron as an intravenous infusion over 5 minutes. Patients were then given incremental doses of atracurium 0.05 mg/kg at 3-minute intervals to establish approximately 95% twitch inhibition so as to construct a dose-response curve. An atracurium infusion was then begun to maintain a constant degree of neuromuscular blockade. At the end of surgery, patients were allowed to recover spontaneously, or pharmacologic antagonism of residual neuromuscular blockade was achieved with neostigmine 0.05 mg/kg and glycopyrrolate 0.01 mg/kg. Mechanomyographic response to train-of-four stimuli (2 Hz for 2 seconds) every 20 seconds was monitored during the atracurium infusion and recovery from neuromuscular blockade. MEASUREMENTS AND MAIN RESULTS: Log dose-response curves were determined for the study groups and compared using analysis of variance (ANOVA). The 50%, 75%, and 95% effective doses (ED50, ED75, and ED95) were calculated from the equation describing the log dose-response. Maintenance infusion rates were determined, and the neostigmine-accelerated recovery index of 25% to 75% was measured for each group. The results were compared using ANOVA. There were no significant differences among the treatment groups with respect to maintenance infusion rate (7.8 +/- 1.8 micrograms/kg/min for Group 1, 7.7 +/- 2.5 micrograms/kg/min for Group 2, and 7.3 +/- 2.3 micrograms/kg/min for Group 3) or neostigmine-accelerated recovery interval of 25% to 75% (4.5 +/- 2.3 minutes, 4.4 +/- 3.1 minutes, 6.6 +/- 3.9 minutes in Groups 1, 2, and 3, respectively). The log dose-response data for Groups 1, 2, and 3 did not differ significantly (p = 0.068), and the calculated ED95 in each treatment group demonstrated no dose-related change (0.254 +/- 0.022, 0.279 +/- 0.033, and 0.240 +/- 0.022 for Groups 1, 2, and 3, respectively). CONCLUSIONS: Ondansetron is an antiemetic drug that can be used in the perioperative period without concern for potentiation of nondepolarizing neuromuscular blockade, change in atracurium maintenance dose, or change in rate of neostigmine-induced recovery from neuromuscular blockade with atracurium.

Adult↗

PubMed2000

A comparison of antagonism of rocuronium-induced neuromuscular blockade during sevoflurane and isoflurane anaesthesia.

Volatile anaesthetic agents potentiate neuromuscular blocking agents and retard their rate of reversal. We hypothesised that there was a difference in the rate of reversal of rocuronium-induced neuromuscular blockade based on the selection of inhalation agent. Thirty-eight patients undergoing elective surgical procedures received either sevoflurane or isoflurane, by random allocation. Neuromuscular blockade was induced using rocuronium 0.6 mg.kg-1 followed by continuous intravenous infusion to maintain 90% suppression of the single twitch response. Upon completion of surgery, the rocuronium infusion was discontinued, neostigmine 50 microg.kg-1 and glycopyrrolate 10 microg.kg-1 were administered. Times from reversal to T1 = 25, 50 and 60% and train-of-four ratio = 0.6 were recorded. The mean (SD) times to train-of-four ratio = 0.6 in the isoflurane and sevoflurane groups were 327 (132) and 351 (127) s, respectively. The mean (SD) times to single twitch response T1 = 25, 50 and 60% in the isoflurane group were 81 (33), 161 (59) and 245 (84) s, respectively, and in the sevoflurane group were 95 (35), 203 (88) and 252 (127) s, respectively. It is concluded that reversal of rocuronium-induced neuromuscular blockade is similar during isoflurane and sevoflurane anaesthesia.

Adult↗

PubMed1980

The antagonism of nondepolarizing neuromuscular blockade.

The antagonism of the nondepolarizing neuromuscular blockade is accomplished many times in a given day. Fortunately, the incidents of complications are low. If they do occur and are not recognized and treated properly, however, the results can be serious. In this article, the author reviews the curariform group of drugs, anticholinesterases, and anticholinergics, evaluating the antagonism of the nondepolarizing neuromuscular blockade.

Cholinesterase Inhibitors↗

PubMed2001

Video imaging to assess neuromuscular blockade at the larynx.

UNLABELLED: We describe video imaging as a technique for assessing neuromuscular blockade at the larynx. We sought to determine the stability and reproducibility of this technique and to compare the effect of succinylcholine at the adductor pollicis and the larynx. Ten patients were studied. Anesthesia was induced and maintained with propofol. The recurrent laryngeal nerve was stimulated superficially and movements of the vocal cords were recorded on videotape by using a fiberoptic bronchoscope passed via a laryngeal mask airway. Neuromuscular function was recorded at the adductor pollicis by using a mechanomyograph. Twenty images of the vocal cords were examined repeatedly by one investigator and by ten independent observers. The mean difference between the two sets of observations was 0.86 degrees with a correlation coefficient (r) of 0.997. For 3 min before the administration of relaxant the coefficient of variation in the cord movement during supramaximal stimulation ranged from 1%-4% (median 2.7%). After the administration of succinylcholine 1 mg. kg(-1) the times to loss of T1 at the larynx and hand were 63 +/- 15 s and 63 +/- 12 s respectively. Times to 25% recovery were 215 +/- 36 s at the larynx and 436 +/- 74 s at the hand and times to 75% recovery were 285 +/- 55 s and 525 +/- 85 s respectively. These results indicate that video imaging may be a useful research technique for estimating neuromuscular blockade at the larynx and that the time to onset of succinylcholine at the larynx is similar to that at the hand, whereas the duration of blockade is significantly shorter at the larynx. IMPLICATIONS: Assessment of neuromuscular blockade at the larynx is possible by using a video imaging technique. By using this technique, the time to onset of neuromuscular blockade at the larynx is similar to that at the hand after the administration of succinylcholine; this finding is different from previously published data obtained by using a cuff pressure measurement technique.

Adult↗

PubMed2002

The effect of neuromuscular blockade on oxygen supply, consumption, and total chest compliance in patients with high oxygen requirements undergoing mechanical ventilation.

We investigated the effects of neuromuscular blockade with atracurium on oxygen consumption, oxygen delivery and total chest compliance in 20 sedated intensive care patients who required mechanical ventilation with an inspired oxygen fraction of at least 0.6. The reverse Fick method was used to measure oxygen consumption. Total chest compliance was measured from the ventilator pneumotachograph and pressure transducer. Measurements were made before neuromuscular blockade, at a standard level of neuromuscular blockade, and after demonstrated recovery of neuromuscular function. There was no statistical difference in any of the parameters measured. However there were large changes in oxygen consumption (range -35% to +17%) and total chest compliance (range -19.7% to +9.7%) in individuals. We conclude that in the setting of critical oxygenation, neuromuscular blockade cannot be assumed to reduce oxygen requirements or improve total lung compliance. If, however, neuromuscular blockade is selected as an adjunct to therapy, we recommend that the indices of oxygenation are calculated.

Adolescent↗

PubMed2001

[Sevoflurane augments the degree and speeds the onset of rocuronium evoked neuromuscular blockade in children].

BACKGROUND: In adults, sevoflurane augments the intensity of rocuronium evoked neuromuscular blockade. However, in children effective doses and onset of action of rocuronium have not been reported during sevoflurane anaesthesia. To test in children the hypothesis that sevoflurane speeds the onset and potentiates the degree of rocuronium induced neuromuscular blockade we studied 50 children aged 2 - 7 years following approval by the local ethics committee. METHODS: After induction and maintenance of anaesthesia with either 2 % endtidal sevoflurane in 60 % N(2)O/O(2) (n = 30) or with propofol (3 mg small middle dot kg(-1) and 10 mg small middle dot kg(-1)h(-1), n = 20) and 60 % N(2)O/O(2) for 17 +/- 1 min, we injected either 0.15, 0.22, or 0.3 mg small middle dot kg(-1) rocuronium and quantified by mechanomyography the evoked (0.1 Hz ulnar nerve stimulation) response of the adductor pollicis muscle. Dose-response relationships of rocuronium under both anaesthetic regimes were assessed using a generalised linear model based on the maximum-likelihood-technique. Data were compared by analysis of covariance, F-test, and Mann-Whitney-U-test as indicated, p < 0.05, mean +/- SD, (95% confidence interval). RESULTS: The degree of neuromuscular blockade was greater (p < 0.05) during sevoflurane (estimated ED 50: 0.15 (0.076 - 0.177) mg small middle dot kg(-1)) than propofol (ED 50: 0.25 (0.15 - 0.35) mg small middle dot kg(-1)) anaesthesia. Furthermore, onset time was significantly faster under sevoflurane/N(2)O compared to propofol/N(2)O anaesthesia (110 +/- 31 versus 230 +/- 52 s, p < 0.01, after rocuronium 0.3mg small middle dot kg(-1)). CONCLUSION: In young children during steady state anaesthesia onset of action of rocuronium is halved and the degree of neuromuscular blockade is markedly augmented during sevoflurane/N(2)O anaesthesia compared to propofol.

Androstanols↗

PubMed1999

[Utility of double burst stimulation in the detection of residual neuromuscular blockade].

OBJECTIVE: To assess the usefulness of double burst stimulation (DBS) for detecting neuromuscular blockade caused by atracurium and vecuronium. PATIENTS AND METHODS: One hundred nineteen adult patients were randomly assigned to receive atracurium (n = 62) or vecuronium (n = 57), with electromyographic monitoring of the number of responses to train of four (TOF) stimuli, TOF-ratio (TR) and the amplitude of the first TOF response (T1) in the pollicis adductor and the response to neurostimulator DBS in the contralateral forearm. During recovery from neuromuscular blockade an independent anesthesiologist manually assessed two responses to DBS every minute as being clearly differentiated, doubtful or undifferentiated. The results were later compared to T1 and TR. RESULTS: Significant differences (p < 0.05) between groups were observed for TR in doubtful (0.27 +/- 0.18 and 0.34 +/- 0.17 for atracurium and vecuronium, respectively) and undifferentiated (0.34 +/- 0.22 and 0.43 +/- 0.18, respectively) responses to DBS, and for T1 with three TOF responses (26.0 +/- 13.6 and 33.1 +/- 14.2, respectively) or four responses (30.9 +/- 14.1 and 38.7 +/- 18.4, respectively). T1 values when TR was 0.75 (extubation criterion) were 68.1 +/- 23.8% and 60.5 +/- 17.4% for the atracurium and vecuronium groups, respectively (NS). CONCLUSIONS: Assuming that DBS reduces the risk of residual curarization and that a TOF-ratio greater than 0.75 indicates adequate recovery from neuromuscular blockade, manual assessment of DBS response as obtained in this study indicates curarization and equal responses do not guarantee its absence. The most reliable index of recovery from neuromuscular blockade is the TR obtained by electromyographic monitoring.

Adult↗

PubMed1992

Powerlessness and the patient under neuromuscular blockade.

The patient under neuromuscular blockade is dependent on members of the interdisciplinary team for all physical and psychological needs. Loss of control leads to feelings of powerlessness and helplessness which can adversely affect the patient's ability to cope. The nurse caring for this patient must be able to effectively combine clinical expertise with compassion in order to most effectively help the patient cope with the period of powerlessness. An individualized approach to restore control helps curtail the progression of powerlessness to hopelessness and limit the associated depression and anxiety.

Humans↗

PubMed2003

Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone.

PURPOSE: To study accelerographic monitoring of neuromuscular blockade over the vastus medialis muscle in anesthetized patients in the prone position. METHODS: Sixty adult patients were divided into four groups of 15: prone (P)-post-tetanic count (PTC), P-train-of-four (TOF), supine (S)-PTC or S-TOF group. In the P-PTC and P-TOF groups, the muscular branch of the femoral nerve was stimulated and the movement of the vastus medialis muscle was measured accelerographically. In the S-PTC and S-TOF groups, the depth of neuromuscular blockade was assessed mechanically at the thumb. After administration of vecuronium 0.1 mg.kg(-1), TOF stimuli were delivered every 20 sec in all groups. Onset of neuromuscular blockade (time from vecuronium to the minimum level of T1 (first response of TOF) was compared between the P-PTC or P-TOF group and S-PTC or S-TOF group. Recoveries of PTC and those of TOF were compared between the P-PTC and S-PTC groups and P-TOF and S-TOF groups, respectively. RESULTS: Onset of neuromuscular blockade in the P-PTC or P-TOF group was shorter than in the S-PTC or S-TOF group (132 +/- 43 vs 233 +/- 40 sec, mean +/- SD, P < 0.001). Recoveries of PTC in the P-PTC and S-PTC groups followed a similar time course. Recoveries of T1/control in the P-TOF and S-TOF groups were also comparable. In contrast, train-of-four ratio (T4/T1, TOFR) in the P-TOF group was higher than in the S-TOF group 60-120 min after vecuronium (P < 0.05). CONCLUSIONS: The degree of neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle even when patients are in the prone position. When evaluated accelerographically over the vastus medialis muscle, onset of neuromuscular blockade is quicker and TOFR is higher than that assessed at the thumb.

Analysis of Variance↗

PubMed2001

High concentration sevoflurane induction of anesthesia accelerates onset of vecuronium neuromuscular blockade.

PURPOSE: To investigate neuromuscular block using accelography after administration of vecuronium under sevoflurane 8% induction and maintenance with sevoflurane 2% in adults. METHODS: Patients were allocated to three groups: (1) group I: anesthesia was induced and maintained with propofol and fentanyl (n= 15), (2) group II: anesthesia was induced with propofol and maintained with N2O(66%)-O2-sevoflurane 2% (n = 15), (3) group III: anesthesia was induced with sevoflurane 8% using a vital capacity inhalation induction and maintained with N2O(66%)-O2-sevoflurane 2% (n = 15). 0.1 mg x kg(-1) vecuronium was used for paralysis three minutes after anesthetic induction and reversed using intravenous 0.04 mg x kg(-1) neostigmine with 0.02 mg kg atropine when the train-of-four (TOF) ratio returned to 25%. RESULTS: The onset time from initial administration of vecuronium to maximal block in the group III was shorter than that in the groups I and II (139 +/- 35, 193 +/- 35 and 188 +/- 47s, respectively: P < 0.05). The clinical duration from maximal block to 25% recovery of TOF ratio in group II and III was longer than that in the group I (47 +/- 15, 48 +/- 14 and 36 +/- 10 min, respectively: P < 0.05). The reversal times from administration of neostigmine to 75% of TOF ratio in groups II and III were longer than that in the group I (196 +/- 53, 208 +/- 64 and 136 +/- 28s, respectively: P < 0.05). CONCLUSIONS: Vital capacity inhalation induction of anesthesia with sevoflurane accelerates onset and prolongs duration of vecuronium neuromuscular block compared with propofol-fentanyl anesthesia.

Adjuvants, Anesthesia↗

PubMed1997

Improved oxygenation after discontinuing neuromuscular blockade.

OBJECTIVE: To evaluate the effects of prolonged neuromuscular blockade (NMB) on oxygenation and duration of mechanical ventilation in children with respiratory failure. DESIGN: Retrospective case control study. SETTING: The pediatric intensive care unit (PICU) of a tertiary university hospital. PATIENTS: All children (n = 68) in the PICU ventilated for pulmonary parenchymal disease for 3 days or longer over a 4 1/2 year period. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Diagnoses, pediatric risk of mortality scoring, indications for, and duration of, mechanical ventilation and neuromuscular blockade, and blood gas data with corresponding ventilator parameters were extracted from the medical records. Twenty-eight patients received NMB at the initiation of mechanical ventilation and this was continued for 72 h or longer. Cessation of NMB was associated with a significant improvement in ventilator parameters and oxygenation index. The subset of children with respiratory syncytial virus disease (RSV) receiving prolonged NMB had longer ventilator courses compared to those in whom NMB was not used, despite similar demographics, severity of illness and oxygenation impairment. CONCLUSIONS: Stopping NMB is associated with a rapid improvement in oxygenation and prolonged use of NMB in children with RSV is associated with a protracted ventilatory course. DEFINITION: Oxygenation index (OI)*: Mean Airway Pressure x FiO2 x 100/PaO2* Higher scores represent deterioration in oxygenation.

Case-Control Studies↗

PubMed1994

Effect of neuromuscular blockade on the elastic properties of the lungs, thorax, and total respiratory system in anesthetized pigs.

OBJECTIVE: To evaluate the effect of neuromuscular blockade on the elastic properties of the lungs, thorax, and total respiratory system in pigs anesthetized to suppress spontaneous breathing. DESIGN: Prospective, randomized, experimental study. SETTING: A research laboratory at a university medical center. SUBJECTS: Eight healthy, anesthetized pigs, weighing 22 to 25 kg. INTERVENTIONS: Pigs, with and without muscular blockade, were mechanically ventilated during an infusion of sodium pentobarbital that was titrated to suppress spontaneous breathing activity. MEASUREMENTS AND MAIN RESULTS: No significant differences were observed between pressure/volume curves of the lungs, the chest wall, and the total respiratory system, as determined by inflating and deflating the lungs during anesthesia, with or without neuromuscular blockade, in random order. Functional residual capacity was 985 +/- 87 mL with neuromuscular blockade and 997 +/- 78 mL without neuromuscular blockade (NS). A comparison of the total respiratory system, lung, and chest wall compliances obtained with and without neuromuscular blockade showed high correlations (total respiratory system compliance [r2 = .86]; chest wall compliance [r2 = .83]). CONCLUSION: Neuromuscular blockade does not alter the elastic properties of the lungs, chest wall, or total respiratory system in mechanically ventilated pigs receiving sodium pentobarbital anesthesia to suppress spontaneous breathing efforts.

Analysis of Variance↗

PubMed1995

Effect of neostigmine at different levels of mivacurium-induced neuromuscular blockade.

The effectiveness of neostigmine 40 micrograms/kg for antagonism of two different levels of neuromuscular blockade, induced by a bolus dose of mivacurium 0.15 mg/kg, was studied in 45 patients. The patients were anaesthetized with thiopentone, fentanyl, nitrous oxide in oxygen, and enflurane. Neostigmine was administered at either 10% recovery of the twitch height (TH10) at the adductor pollicis muscle (n = 14) or upon reappearance of the first response at the orbicularis oculi muscle (OO1) after train-of-four (TOF) stimulation (n = 16), the latter representing a deeper degree of neuromuscular blockade. Fifteen of the 45 patients did not receive neostigmine (control group). Neostigmine administration at OO1 rather than at TH10 at the adductor pollicis muscle caused reversal of neuromuscular blockade to occur 8 min earlier and shortened the time to reach 25% recovery of the twitch height (TH25) at the adductor pollicis muscle by about 5 min, compared with the control group. However, the time needed to reach a T4/T1 ratio > or = 0.8 was similar in both the early and late neostigmine administration groups, being 9 min faster than in the control group. It can be concluded that there is no advantage in administering neostigmine at profound neuromuscular blockade to achieve clinically adequate recovery (T4/T1 ratio > or = 0.8). However, the time between injection of mivacurium and TH25 may be shortened by using neostigmine at profound neuromuscular blockade, a procedure which may be useful in case of unpredictably difficult intubation, since diaphragmatic movements usually reappear at TH25.

Adolescent↗

PubMed2005

[Residual neuromuscular blockade].

Despite the availability of modern neuromuscular blocking agents with short or intermediate duration of action, incidence of residual neuromuscular blockade remains very high. Evidences have been recently provided that residual curarization must be defined as a train-of-four ratio below 0.9 at the thumb adductor during the recovery period after anaesthesia. Residual curarization may be associated with serious adverse events related to respiratory depression, pharyngeal dysfunction, hypoxemia and prolongation of the length of stay in the recovery room. Appropriate choice of drugs, perioperative monitoring of neuromuscular function and large indications of pharmacological reversal may reduce the incidence of residual curarization and improve the patient's safety in the postoperative setting.

Humans↗

PubMed1998

[PARAGRAPH as a neuromuscular blockade monitor].

To assess the clinical performance of a new neuromuscular blockade monitor "PARAGRAPH", we studied adults and pediatric patients during general anesthesia. PARAGRAPH enables anesthesiologists to perform various types of assessment of neuromuscular blockade, including TOF, DBS and single twitch even with children. The most remarkable point is its capability for analysis and printing by personal computer. We conclude this device is portable and easy to use, as well as a clinically reliable neuromuscular blockade monitor.

Adult↗

PubMed1986

Neostigmine and edrophonium antagonism of varying intensity neuromuscular blockade induced by atracurium, pancuronium, or vecuronium.

To compare the time course of neostigmine and edrophonium antagonism of varying intensity neuromuscular blockade induced by atracurium, pancuronium, or vecuronium, the authors studied 98 patients anesthetized with nitrous oxide (60%) and halothane or enflurane. Neuromuscular blockade, as monitored by single stimulus-induced twitch tension (TT), was antagonized at varying degrees of spontaneous recovery (2-80% of control TT). Time to antagonism (time from injection of neostigmine or edrophonium to 90% recovery of control TT) was not different between edrophonium, 0.5 mg/kg, and neostigmine, 0.04 mg/kg, when spontaneous recovery had been allowed to occur to at least 11% of control TT prior to antagonist administration (P greater than 0.05). For profound neuromuscular blockade (TT less than or equal to 10% of control) induced by pancuronium or vecuronium, time (mean +/- SD) to antagonism with neostigmine, 0.04 mg/kg, was 7.0 +/- 2.2 min and 5.6 +/- 1.7 min, respectively, while the same for edrophonium, 0.5 mg/kg, was 20.0 +/- 8.0 min and 15.0 +/- 12.5 min, respectively (P less than 0.05). Time to antagonism of profound atracurium-induced neuromuscular blockade was 8.5 +/- 3.3 min for neostigmine, 0.04 mg/kg, and 9.8 +/- 7.0 min for edrophonium, 0.5 mg/kg, (P less than 0.05). For profound vecuronium-and pancuronium-induced neuromuscular blockade, time to antagonism by edrophonium, 1.0 mg/kg, was 4.6 +/- 3.0 min and 3.9 +/- 1.6 min respectively. The authors conclude that neostigmine, 0.04 mg/kg, antagonizes neuromuscular blockade within 12 min when TT is greater than 2% of control at time of reversal. When TT is greater than 10% of control, edrophonium, 0.5 mg/kg, produces similar time to antagonism.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗