Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii

Dhonneur, Gilles; Kirov, K.; Motamed, Cyrus; Amathieu, R.; Kamoun, Walid S.; Slavov, V.; N’Doko, S

doi:10.1093/bja/aem124

Cited by 55 publications

(27 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Dhonneur et al have proven that PTC values ≤5 show deep NMB for diaphragm when measured from adductor pollicis muscle. 21 The TOF values measured from corrugator supercillii muscle failed to reveal deep NMB of diaphragm. It has been shown that pharyngeal and upper esophageal sphincter function, thus a safe swallowing function, can be fulfilled only after TOFR values >0.9.…”

Section: Discussionmentioning

confidence: 95%

Effects of Epidural Bupivacaine on the Doses of Propofol, Alfentanil, Vecuronium, and Neuromuscular Block: A Prospective Randomized, Single-Blind Clinical Study

Karlilar¹,

Tunç²,

Sazak³

et al. 2013

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 95%

Effects of Epidural Bupivacaine on the Doses of Propofol, Alfentanil, Vecuronium, and Neuromuscular Block: A Prospective Randomized, Single-Blind Clinical Study

Karlilar¹,

Tunç²,

Sazak³

et al. 2013

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

“…Diaphragmatic movements can result in hiccups, bucking, or coughing which may have grave consequences during delicate surgical interventions like laser ophthalmic surgery, neurosurgical procedures, and endoscopic thoracic surgery. It has been recommended to keep the PTC below 5 in order to prevent significant diaphragmatic recovery [12]. Since the diaphragm recovers much faster than any other skeletal muscles, the anesthesiologist should not wait for the adductor pollicis first response to TOF stimulation to appear before administering a maintenance dose of the NMBD [13].…”

Section: Discussionmentioning

confidence: 99%

“…Since the diaphragm recovers much faster than any other skeletal muscles, the anesthesiologist should not wait for the adductor pollicis first response to TOF stimulation to appear before administering a maintenance dose of the NMBD [13]. The depth of NMB can be maintained by titrating NMBD administration when the PTC has recovered to 5 rather than waiting for T 1 to appear by which time the diaphragm could have recovered to 25% of the control values and coughing or bucking may be imminent if not already occurring [12]. On the other hand, at the end of surgery, the anesthesiologist can predict the recovery time for T 1 and accordingly plan the time of reversal drug administration.…”

Section: Discussionmentioning

confidence: 99%

Post-Tetanic Count Recovery after Cisatracurium in Elderly Patients

El-Orbany¹,

Joseph²,

Salem³

2011

J Anesthe Clinic Res

View full text Add to dashboard Cite

Background: The temporal relationship between recovery of a certain post-tetanic count (PTC) and the recovery of the first twitch (T 1 ) in the train-of-four (the PTC-T 1 interval), is specific for each neuromuscular blocking drug (NMBD). A previous study reported prolongation of the PTC -T 1 interval in the elderly after rocuronium. The ability to accurately predict the return of T 1 is an important component of PTC monitoring since it may affect clinical decisions about administration versus withholding a maintenance dose of the NMBD. This study was designed to evaluate PTC recovery from intense cisatracurium-induced NMB in geriatrics and investigate its relationship with T 1 . Methods:After IRB approval, Thirty-two patients who are older than 65yr were recruited and the informed consent signed. After anesthesia induction, neuromuscular monitoring was performed using acceleromyography. Cisatracurium 0.15 mg/kg was administered and tracheal intubation performed when the response to TOF stimulation was abolished. Cycles of post-tetanic stimulation were applied every 6 minutes with TOF monitoring in between. Anesthesia was maintained with propofol infusion and nitrous oxide in oxygen 60:40. Measurements included time to reappearance, and number of PTC, time to T 1 , and the number of PTC when T 1 was imminent. The correlation between PTC and T 1 was also studied.Results: 32 subjects were studied 32. The mean time needed for the first response to post-tetanic stimulation (PTC 1 ) to appear was 34.4 ± 5.5 minutes and the mean time needed for T 1 to reappear was 45.7 ± 5.8 minutes. The median number of detectable PTC just before or coinciding with T 1 appearance was 9. There was a strong correlation between the number of detectable PTC and time to T 1 appearance (Correlation coefficient 0.929). Conclusions:There is a consistent temporal relationship between the number of PTC and the time to T 1 recovery after cisatracurium in elderly patients. This may allow more accurate control and predictable recovery from intense cisatracurium-induced block in the elderly.

show abstract

“…Myoresolution plays a crucial role in laparotomic and laparoscopic general surgery, including orthotopic liver transplantation (OLT), where a deep level of neuromuscular block (NMB) has been shown to provide better surgical conditions. 1,2 Deep NMB, defined as ≤ 2 responses after post-tetanic stimulation (or 'post-tetanic count', PTC), requires higher doses of a neuromuscular blocking drug (NMBD), with a consequent higher risk of longer and unpredictable recovery times regardless of the agent used [3][4][5] . The use of NMBD at high dosages to achieve deep NMB may also be associated with increased postoperative residual curarization (PORC) that leads to pulmonary complications and may even hinder successful extubation [6][7][8] Both the administration of NMBD reversal agents at the end of surgery and the use of neuromuscular transmission (NMT) monitoring throughout the surgical procedure are key factors to counteract the adverse outcomes related to impaired neuromuscular transmission after extubation.…”

Section: Introductionmentioning

confidence: 99%

Sugammadex versus neostigmine after rocuronium continuous infusion in patients undergoing liver transplantation.

Deana

Barbariol

D’Incà’³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation. Methods The TOF-Watch SX®, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software®, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results Data from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times±SD of 9.4±4.6 min and 34.6±24.9 min, respectively (p<0.0001). Conclusion Sugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice. Trial registration: ClinicalTrials.gov NCT02697929. Keywords: rocuronium, neostigmine, reversal, recovery time, liver transplantation.

show abstract

Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii

Abstract: PTC(AP) may better reflect early recovery of vecuronium-induced DIA paralysis than TOF(CSC). The findings suggested that PTC(AP)

Cited by 55 publications

References 11 publications

Effects of Epidural Bupivacaine on the Doses of Propofol, Alfentanil, Vecuronium, and Neuromuscular Block: A Prospective Randomized, Single-Blind Clinical Study

Effects of Epidural Bupivacaine on the Doses of Propofol, Alfentanil, Vecuronium, and Neuromuscular Block: A Prospective Randomized, Single-Blind Clinical Study

Post-Tetanic Count Recovery after Cisatracurium in Elderly Patients

Sugammadex versus neostigmine after rocuronium continuous infusion in patients undergoing liver transplantation.

Contact Info

Product

Resources

About