Visual Evaluation of Residual Curarization in Anesthetized Patients Using One Hundred-Hertz, Five-Second Tetanic Stimulation at the Adductor Pollicis Muscle

Baurain, Michel; Hennart, Daniele A.; Godschalx, Alexandre; Huybrechts, Isabelle; Nasrallah, Georges; D’Hollander, Alain; Cantraine, Francis

doi:10.1213/00000539-199807000-00038

Cited by 33 publications

(14 citation statements)

References 19 publications

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“…This overlaps the range of concentrations used in our experimental conditions in vitro. So, it is fair to suppose that the mechanisms we disclosed for atracurium in vitro in the present work are also operative in vivo in the clinical setting, where atracurium is known to induce fade of the tetanic contraction (Payne & Hughes 1981; Baurain et al 1998) with similar characteristics to the fade observed in vitro in the present work.…”

Section: Discussionsupporting

confidence: 67%

“…An important question regarding any in vitro study such as the present one, is whether the findings can be extrapolated to the in vivo situation and ideally to the clinical setting. In this regard, the effective plasma concentrations attained by atracurium in patients, calculated from its usual range of doses (0.3 to 0.6 mg/kg, Payne & Hughes 1981; Baurain et al 1998), volume of distribution (0.16 l/kg, Ward et al 1983) and molecular weight (1243.4, Stenlake et al 1983) is in the range of 1.5 to 3.0 μM. This overlaps the range of concentrations used in our experimental conditions in vitro.…”

Section: Discussionmentioning

confidence: 99%

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Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Nascimento

Serra

Oliveira

2004

Basic Clin Pharma Tox

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Although atracurium is a widely used neuromuscular blocker, we still lack knowledge regarding some of its cellular mechanisms of action. Thus, similar to other clinically used blockers atracurium induces, both in vivo and in vitro, fade of the tetanic contraction. However, the cellular mechanisms underlying this tetanic fade have never been systematically studied. In the present work these mechanisms were investigated in vitro. A sciatic nerve extensor digitorum longus muscle preparation of the rat was used. A combination of myographical and electrophysiological techniques was employed. Indirect twitches were evoked at 0.1 Hz and tetanic contractions at 50 Hz. Trains of end-plate potentials were evoked at a frequency of 50 Hz. The electrophysiological variables used in the analysis of the trains of end-plate potentials were: peak amplitude of the first end-plate potential in the train, peak amplitude of plateau end-plate potentials in the train, tetanic run-down of the end-plate potentials' train, quantal content of first and plateau end-plate potentials in the train, quantal size. In the myographical study atracurium, at a concentration of 2.4 mM, induced a complete fade of the tetanic contraction while only slightly affected the twitch. In the electrophysiological study atracurium, at the same 2.4 mM concentration, significantly decreased the amplitude of both first end-plate potentials in the train (control: 14.4 mV; atracurium: 3.2 mV) and plateau end-plate potentials (control: 10.8 mV; atracurium: 2.4 mV) and reinforced the tetanic run-down of the train of end-plate potentials, evaluated as the percent loss in amplitude of plateau end-plate potentials compared to first end-plate potentials in the trains (control: 25.2%; atracurium: 33.2%). Atracurium also significantly decreased the quantal content of first end-plate potentials in the train (control: 231; atracurium: 68), the quantal content of plateau end-plate potentials (control: 159; atracurium: 42) and the quantal size (control: 0.119 mV; atracurium: 0.075 mV). In relative terms the decrease in quantal content was about twice as large as the decrease in quantal size. This indicates that the fade of the tetanic contraction induced by atracurium (2.4 mM) is due to both pre-and postsynaptic blocking effects, the presynaptic one being stronger.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Nascimento

Serra

Oliveira

2004

Basic Clin Pharma Tox

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“…Above a TOF ratio of 0.8, we cannot detect visually fade even in tetanic responses at the adductor pollicis muscle. 16 It is therefore recommended that neuromuscular function should be monitored objectively during combined general and epidural anaesthesia. Although there is a statistically significant difference in the time for antagonism to a TOF ratio of 0.9 between the epidural group and the control group, the difference is only 1 -2 min and has only limited clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Epidurally administered mepivacaine delays recovery of train-of-four ratio from vecuronium-induced neuromuscular block

Suzuki

Mizutani

Ishikawa

et al. 2007

British Journal of Anaesthesia

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“…12 Tetanic fade after 100-Hz stimulation can be detected at a TOFR of 0.8 -0.9, making it a more sensitive test. 13 However, this stimulation is very painful and must not be used on the awake patient. Also, it produces a posttetanic facilitation period of 5-10 min, during which the response to any test (TOF, DBS, or tetanus) is enhanced, spuriously indicating more recovery than is actually the case.…”

Section: Qualitative Assessmentmentioning

confidence: 99%

Residual Paralysis after Emergence from Anesthesia

et al. 2010

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Support was provided solely from institutional and/or departmental sources. Benoît Plaud and Bertrand Debaene have participated in the clinical development of sugammadex as coinvestigators in two phase III studies funded by Schering-Plough Corporation, Oss, The Netherlands. François Donati and Jean Marty have no conflicts of interest. The figures and tables in this article were prepared by Dimitri Karetnikov, 7 Tennyson Drive,

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Visual Evaluation of Residual Curarization in Anesthetized Patients Using One Hundred-Hertz, Five-Second Tetanic Stimulation at the Adductor Pollicis Muscle

Cited by 33 publications

References 19 publications

Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Cellular Mechanisms of Atracurium‐Induced Tetanic Fade in the Isolated Rat Muscle

Epidurally administered mepivacaine delays recovery of train-of-four ratio from vecuronium-induced neuromuscular block

Residual Paralysis after Emergence from Anesthesia

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