Relationship of the Train-of-four Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers

Kopman, Aaron F.; Yee, Pamela S.; Neuman, George G.

doi:10.1097/00000542-199704000-00005

Cited by 340 publications

(107 citation statements)

References 25 publications

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“…It has been shown that a mechanical TOFR > 0.9 correlates well with signs of adequate recovery of neuromuscular blockade. 12 Hence, when measured accelerographically, it may be difficult to diagnose adequate recovery from neuromuscular blockade since the accelerographic TOFR is prone to be higher than the mechanical TOFR. May et al 13 noted that T1/control measured accelerographically was not different from that measured mechanically.…”

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RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone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

RETRACTED ARTICLE: Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone

et al. 2003

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“…También se ha observado cómo pequeños grados de parálisis residual producen una disminución de la respuesta ventilatoria a la hipoxia y la aparición de sintomatología de malestar asociada a la presencia de debilidad muscular en el paciente despierto. En voluntarios sanos ASA 1 un ratio entre 0.7-0.75 se asoció a diplopía y alteraciones visuales, incapacidad para la sedestación sin ayuda, incapacidad para mantener la mordida, debilidad de la musculatura facial y dificultad para hablar y beber 107 .…”

Section: Bloqueo Neuromuscular Residual (Bnmr)unclassified

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Ruiz

Cayuela

Montes

et al. 2017

Revista Española de Anestesiología y Reanimación

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“…Regarding Copp's comments, residual residual neuromuscular blockade following extubation is associated with a higher incidence of hypoxaemia and upper airway obstruction [3], and extubation should therefore be performed with a train-of-four (TOF) ratio of 0.9 or ideally, unity. In clinical practice, without the use of an accelerometer, it is not possible to discriminate between TOF ratios of 0.7 and 0.9, and as volunteer studies have shown, significant signs and symptoms of residual block are seen at a TOF ratio of 0.7 [4]. Sugammadex offers the ability for safer and more reliable reversal of neuromuscular blockade, and where an accelerometer is not present reduces the risks associated with an unrecognised low TOF ratio.…”

Section: A Replymentioning

confidence: 99%

A reply

Popat¹,

Mitchell²,

Dravid³

et al. 2012

Anaesthesia

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Relationship of the Train-of-four Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers

Cited by 340 publications

References 25 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

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

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