Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography

Kitajima, Toshimitsu; Ishii, Keiichi; Kobayashi, Toshiya; Ogata, Hiromaru

doi:10.1016/s0952-8180(97)90063-5

Cited by 5 publications

(16 citation statements)

References 2 publications

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“…[5][6][7][8] During surgery of the cervical spine or neurosurgical procedures in a prone position, neuromuscular blockade is difficult to assess accelerographically at the first toe since the patient's feet and arms are fixed on the operating table. In such cases, the degree of neuromuscular blockade can be evaluated electromyographically at the gastrocnemius muscle.…”

Section: P-ptc S-ptc P-tof S-tofmentioning

confidence: 99%

“…10 As the percentage of type II muscle fibres increases, the skeletal muscle becomes more resistant to a non-depolarizing neuromuscular relaxant and recovery from neuromuscular blockade is hastened. 1,[5][6][7][8] Because the vastus medialis muscle is thought to be more resistant to non-depolarizing neuromuscular blocking drugs than the adductor pollicis muscle, TOFR assessed over the vastus medialis muscle was higher than that measured at the thumb. On the other hand, accelerographic TOFR is comparable to mechanical TOFR in the mechanical TOFR range of 0 to 0.70.…”

Section: P-ptc S-ptc P-tof S-tofmentioning

confidence: 99%

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RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

et al. 2003

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P Pu ur rp po os se e: : To study accelerographic monitoring of neuromuscular blockade over the vastus medialis muscle in anesthetized patients in the prone position.M Me et th ho od ds s: : 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. R Re es su ul lt ts s: : 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).C Co on nc cl lu us si io on ns s: : 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.Objectif : Étudier la mesure accélérographique du blocage neuromusculaire du muscle vaste interne chez des patients anesthésiés en décubitus ventral. moyenne ± l'écart type, P < 0,001 Méthode : Soixante adultes ont été répartis en quatre groupes de 15 : compte post-tétanique en décubitus ventral (CPT-V), train-de-quatre-V (TDQ-V), CPT-D en décubitus dorsal ou TDQ-D. Dans les groupes CPT-V et TDQ-V, la branche musculaire du nerf fémoral a été stimulée et le mouvement du muscle vaste interne mesuré par accélérographie. Dans les groupes CPT-D et TDQ-D, la profondeur du blocage neuromusculaire a été évaluée mécaniquement au pouce. Après l'administration de 0,1 mg·kg -1 de vécuronium, des stimuli en TDQ ont été administrés à toutes les 20 sec chez tous les patients. L'installation du bloc, c'est-à-dire le temps entre l'administration du vécuronium et le niveau minimal de T1 (première réponse au TDQ), a été comparée entre les groupes CPT-V ou TDQ-V et les groupes CPT-D et TDQ-D. La récupération du CPT et celle du TDQ ont été respectivement comparées entre CPT-V et CPT-D et entre TDQ-V et TDQ-D. Résultats: L'installation du bloc dans le groupe CPT-V ou TDQ-V a été plus courte que dans le groupe

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Section: P-ptc S-ptc P-tof S-tofmentioning

confidence: 99%

Section: P-ptc S-ptc P-tof S-tofmentioning

confidence: 99%

RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

et al. 2003

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“…75 [11][12][13][14][15]. Saitoh et al [15] compared the recovery times from 0.2 mg/kg of vecuronium at the adductor pollicis and flexor hallucis brevis muscles using acceleromyography, and reported that recovery to TOFR 0.2 and 0.6 was significantly faster at the flexor hallucis brevis muscle.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is difficult to monitor a patient's upper limb responses to neuromuscular blockade if their arms are not accessible because they are involved with the surgery or tucked at their side. In such cases, attaching a neuromuscular monitor to the flexor hallucis brevis muscle of the lower limb is an easy and useful alternative [11][12][13][14][15]. Many studies have compared the recovery of upper and lower limb blockade by non-depolarizing neuromuscular blockers to TOFR < 0.75 [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…In such cases, attaching a neuromuscular monitor to the flexor hallucis brevis muscle of the lower limb is an easy and useful alternative [11][12][13][14][15]. Many studies have compared the recovery of upper and lower limb blockade by non-depolarizing neuromuscular blockers to TOFR < 0.75 [11][12][13][14][15]. A recent study found that TOFR monitoring of eye muscles led to an increased risk of postoperative residual paralysis compared with TOFR monitoring of an upper limb muscle [16].…”

Section: Introductionmentioning

confidence: 99%

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Acceleromyography at the Flexor Hallucis Brevis Muscle Underestimates Residual Neuromuscular Blockade

Sugi¹,

Nitahara²,

Kaneda³

et al. 2013

TOATJ

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Abstract:Purpose: Recovery of the train-of-four ratio (TOFR) to > 0.9 in the upper limb is commonly used to determine that neuromuscular function has returned to the preoperative level. It is not known whether recovery of neuromuscular function can be determined in the same way using lower limb acceleromyography. We compared measurements of recovery from neuromuscular blockade using upper limb electromyography and lower limb acceleromyography.Methods: Twenty-nine patients who were scheduled for elective surgery were enrolled in this study. Patients were excluded if they had neuromuscular disease or contraindications to neuromuscular blockade. General anesthesia was induced and maintained with propofol and fentanyl. Patients were monitored using electromyography at the first dorsal interosseous muscle of the upper limb and acceleromyography at the flexor hallucis brevis muscle of the lower limb. Vecuronium 0.1 mg/kg was administered for neuromuscular blockade, and the profile of the blockade was recorded, including onset time and recovery times to TOFR 0.7 and 0.9. Results were compared between the upper and lower limbs. Results:The first dorsal interosseous muscle of the upper limb was slower to recover to TOFR 0.7 and 0.9 than the flexor hallucis brevis muscle. When the TOFR at the flexor hallucis brevis muscle had recovered to 0.9, the TOFR at the first dorsal interosseous muscle was 0.44 ± 0.23. Conclusion:Monitoring the flexor hallucis brevis muscle using acceleromyography underestimates the residual neuromuscular blockade.

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Brief review: Neuromuscular monitoring: an update for the clinician

Hemmerling

Lê

2007

Can J Anesth/J Can Anesth

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Purpose:To review established techniques and to provide an update on new methods for clinical monitoring of neuromuscular function relevant to anesthesia.Source: A PubMed search of relevant article for the period 1985-2005 was undertaken, and bibliographies were scanned for additional sources. Principal findings:There is no substitute for objective neuromuscular monitoring; for research purposes, mechanomyography (MMG) is the gold standard; however, the most versatile method in the clinical setting is acceleromyography since it can be applied at various muscles and has a long track record of clinical utility. Kinemyography is valid to monitor recovery of neuromuscular transmission at the adductor pollicis muscle (AP), whereas phonomyography is easy to apply to various muscles and shows promising agreement with MMG. Monitoring of the corrugator supercilii muscle (CS) may be used to determine the earliest time for tracheal intubation as it reflects laryngeal relaxation better than monitoring at the AP. Recovery of neuromuscular transmission is best monitored at the AP, since it is the last muscle to recover from neuromuscular blockade (NMB). If train-of-four (TOF) stimulation is used, a TOF-ratio > 0.9 should be the target before awakening the patient. If surgery or the type of anesthesia necessitates NMB of a certain degree, e.g., TOF-ratio = 0.25, monitoring of muscles which best reflect the degree of NMB at the surgical site is preferable. Conclusion:Objective methods should be used to monitor neuromuscular function in clinical anesthesia. Acceleromyography offers the best compromise with respect to ease of use, practicality, versatility, precision and applicability at various muscles.The CS is the optimal muscle to determine the earliest time for intubation, e.g., for rapid sequence induction.

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Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography

Cited by 5 publications

References 2 publications

RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

Acceleromyography at the Flexor Hallucis Brevis Muscle Underestimates Residual Neuromuscular Blockade

Brief review: Neuromuscular monitoring: an update for the clinician

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