Measurement of Evoked Diaphragm Twitch Strength During Anaesthesia

Derrington, M.C.; Hindocha, N.

doi:10.1093/bja/61.3.270

Cited by 8 publications

(6 citation statements)

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“…Other limitations of the technique used here were discussed in detail elsewhere [1,2]. They include the assumption that the Pdi generated by supramaximal phrenic stimulation is equivalent to and thus comparable to adductor pollicis twitch generated by supramaximal ulnar nerve stimulation, the use of halothane for maintaining anaesthesia, and the prior administration of suxamethonium to facilitate tracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

“…and 66% nitrous oxide in oxygen, and opioids were given as required. The drugs used for premedication and analgesia are shown in table I. Evoked twitch in the diaphragm was recorded using the method adapted and validated for use during anaesthesia and surgery by Derrington and Hindocha [2]. In summary, the pressure generated by the diaphragm (transdiaphragmatic pressure (Pdi)) was measured after unilateral phrenic nerve stimulation.…”

Section: Methodsmentioning

confidence: 99%

“…Both the onset of paralysis and the reappearance of twitch occurred in the diaphragm before the adductor pollicis muscle. The method used was described and validated in an accompanying paper [2].…”

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confidence: 99%

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Comparison of Neuromuscular Block in the Diaphragm and Hand After Administration of Tubocurarine, Pancuronium and Alcuronium

Derrington

Hindocha

1991

Survey of Anesthesiology

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The onset and offset of neuromuscular block in the diaphragm and in the adductor pollicis muscle were recorded using unilateral supramaximal stimulation of phrenic and ulnar nerves. Thirty patients were allocated randomly to receive tubocurarine 0.4-0.5 mg kg'', pancuronium 0.07-0.08 mg kg-' or alcuronium 0.2-0.3 mg kg-'. In all cases the onset of neuromuscular block occurred in the diaphragm before adductor pollicis, and spontaneous recovery was evident first in the diaphragm. There was a correlation between the time of spontaneous reappearance of twitch in the diaphragm and in the adductor pollicis only in the patients who received pancuronium (r = 0.97, P < 0.05 for reappearance of the first twitch of the train-offour of each muscle). The duration of paralysis in the diaphragm was less than 5 min in five patients who received tubocurarine and in one who received alcuronium; this corresponded to a period of paralysis in the adductor pollicis muscle of more than 25 min in each case.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Comparison of Neuromuscular Block in the Diaphragm and Hand After Administration of Tubocurarine, Pancuronium and Alcuronium

Derrington

Hindocha

1991

Survey of Anesthesiology

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“…Measurements of evoked transdiaphragmatic (Pdi) pressure have also been used to evaluate neuromuscular block at the diaphragm. [45][46][47][48][49] Two balloons are inserted: one into the esophagus to record pleural pressure and one into the stomach to record intraabdominal pressure. The Pdi is then obtained by electronic subtraction of gastric (intra-abdominal) and esophageal (pleural) pressure.…”

Section: Monitoring Neuromuscular Blockade At the Diaphragmmentioning

confidence: 99%

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Hemmerling

Donati

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To review recent findings concerning neuromuscular blockade and monitoring at the larynx, the diaphragm, and the corrugator supercilii muscle.S So ou ur rc ce e: : This narrative review is based on recent publications. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Neuromuscular blockade at the larynx and the diaphragm is less intense than at the adductor pollicis muscle; the onset and offset of neuromuscular blockade is more rapid. The corrugator supercilii muscle reflects better the time course of neuromuscular blockade of the larynx than the adductor pollicis muscle, is better suited to monitor the onset of neuromuscular blockade for intubation, and should give a better reflection of the time course and degree of neuromuscular blockade of the larynx or the diaphragm. Recovery of neuromuscular function at the end of any procedure is best reflected at the adductor pollicis muscle where neuromuscular transmission is last restored. Clinical monitoring of the larynx or the diaphragm is still limited by the absence of a simple method. Acceleromyography of the corrugator supercilii muscle is prone to artifacts that do not occur during monitoring of the adductor pollicis muscle. Phonomyography, a new method of monitoring that is currently being tested, is based on the phenomenon that muscle contraction creates low-frequency sound waves, which can be detected using special microphones to quantify neuromuscular blockade. This method seems promising because it can be easily used on all muscles of interest.C Co on nc cl lu us si io on n: : Research during the last 15 years has greatly enhanced our knowledge about how muscles react differently to muscle relaxants and has enabled us to achieve better surgical conditions with safer use of muscle relaxants. Interesting technologies have been developed to reliably monitor neuromuscular blockade at the larynx and the diaphragm, but are currently restricted to research settings. Our increased understanding should help us in ongoing efforts to develop the "ideal" muscle relaxant and the "ideal" method of neuromuscular monitoring. Objectif

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“…Measurement of evoked transdiaphragmatic pressure as a form of indirect MMG of the diaphragm has also been used to evaluate NMB. 79 Two balloons are inserted into the esophagus to record pleural pressure and into the stomach to record intra-abdominal pressure. The balloons are connected with air-filled catheters to identical transducers.…”

Section: Neuromuscular Monitoring Of the Diaphragmmentioning

confidence: 99%

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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Measurement of Evoked Diaphragm Twitch Strength During Anaesthesia

Cited by 8 publications

References 0 publications

Comparison of Neuromuscular Block in the Diaphragm and Hand After Administration of Tubocurarine, Pancuronium and Alcuronium

Comparison of Neuromuscular Block in the Diaphragm and Hand After Administration of Tubocurarine, Pancuronium and Alcuronium

Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review

Brief review: Neuromuscular monitoring: an update for the clinician

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