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PubMed1986

Verapamil intensifies neuromuscular blockade produced by gallamine and pancuronium at the chick neuromuscular junction.

Experiments were performed to study the effect of verapamil on neuromuscular transmission and muscle contraction at a chick skeletal muscle-nerve preparation. In addition, the effects and interactions of verapamil with some muscle relaxants were studied in the same preparation. These effects were explored by studying the effects of verapamil on: directly-and indirectly-elicited twitch contractions, and neuromuscular blockade produced by gallamine and pancuronium. The results showed that verapamil (2-200 microM) had a differential effect on the twitch responses; more reductions occurred in the indirectly-elicited twitch tension, whereas the directly-elicited twitch response was reduced only by 20-30% of maximum indirectly-elicited twitch tension. Furthermore, in low concentrations (1-20 microM), verapamil significantly increased the neuromuscular blockade produced by gallamine (28-1280 nM) and pancuronium (18-573 nM). In high concentrations (greater than 200 microM), verapamil completely blocked the indirectly-elicited twitch response and produced a marked contracture in the chick skeletal muscle (1.0 +/- 0.1 g, n = 6). It was concluded that by reducing twitch tension and inhibiting neuromuscular transmission, verapamil increases (intensifies) neuromuscular blockade produced by muscle relaxants, e.g. gallamine and pancuronium.

Animals↗
PubMed1997

[Effects of halothane and sevoflurane on reversal of neuromuscular blockade induced by vecuronium in man].

To evaluate residual effects of inhalational anesthetics after reversal of neuromuscular blocking agent, neuromuscular function was monitored after halothane or sevoflurane anesthesia in thirty-seven patients (ASA physical status I or II) for elective surgery after obtaining informed consent. Electromyograph of the adductor pollicis muscle in response to train of four (TOF) stimulation was monitored throughout the study. The first twitch of TOF (T1; % of its control) and the ratio of the fourth twitch to the first twitch of TOF (T4/T1; TR) were recorded at 0, 2, 5, 10, and 15 min after reversal. The patients were divided into five groups; 1) the fentanyl group (n = 7) received fentanyl/N2O; 2) in the halothane stop group (n = 6), halothane was discontinued at least fifteen minutes before neostigmine administration; 3) in the halothane stable group (n = 7), 0.7% halothane was maintained until fifteen minutes after neostigmine; 4) in the sevoflurane stop group (n = 12), sevoflurane was discontinued fifteen minutes before the reversal; 5) in the sevoflurane stable group (n = 5), 3% sevoflurane was maintained until fifteen minutes after the reversal. Anesthesia was induced by thiopental 4 mg.kg-1 and suxamethonium 1 mg.kg-1 and the patients were intubated. After initial dose of vecuronium 0.1 mg.kg-1, the additional dose of 0.02 mg.kg-1 was administered to maintain T1 under 10% of the control value. At the end of the surgery atropine 0.015 mg.kg-1 and neostigmine 0.04 mg.kg-1 were administered to reverse vecuronium when T1 had recovered to 25% of its control. Halothane groups did not differ from fentanyl group. Recovery of T1 at 15 min was suppressed after discontinuation of sevoflurane (86.0 +/- 8.2%) in comparison with fentanyl (97.0 +/- 8.3%). Both T1 (75.4 +/- 12.2%) and TR (68.0 +/- 12.6%) at 15 min after the reversal during 3% sevoflurane inhalation were below those of the stable group. We conclude that the residual sevofulrane after discontinuation of inhalation may impair the neuromuscular transmission after the reversal of neuromuscular blockade. Neuromuscular function should be monitored after the end of anesthesia even though the patient is fully awake.

Adult↗
PubMed2006

Postoperative upper airway obstruction after recovery of the train of four ratio of the adductor pollicis muscle from neuromuscular blockade.

Anesthetics, and even minimal residual neuromuscular blockade, may lead to upper airway obstruction (UAO). In this study we assessed by spirometry in patients with a train-of-four (TOF) ratio >0.9 the incidence of UAO (i.e., the ratio of maximal expiratory flow and maximal inspiratory flow at 50% of vital capacity [MEF50/MIF50] >1) and determined if UAO is induced by neuromuscular blockade (defined by a forced vital capacity [FVC] fade, i.e., a decrease in values of FVC from the first to the second consecutive spirometric maneuver of > or =10%). Patients received propofol and opioids for anesthesia. Spirometry was performed by a series of 3 repetitive spirometric maneuvers: the first before induction (under midazolam premedication), the second after tracheal extubation (TOF ratio: 0.9 or more), and the third 30 min later. Immediately after tracheal extubation and 30 min later, 48 and 6 of 130 patients, respectively, were not able to perform spirometry appropriately because of sedation. The incidence of UAO increased significantly (P < 0.01) from 82 of 130 patients (63%) at preinduction baseline to 70 of 82 patients (85%) after extubation, and subsequently decreased within 30 min to values observed at baseline (80 of 124 patients, 65%). The mean maximal expiratory flow and maximal inspiratory flow at 50% of vital capacity ratio after tracheal extubation was significantly increased from baseline (by 20%; 1.39 +/- 1.01 versus 1.73 +/- 1.02; P < 0.01), and subsequently decreased significantly to values observed at baseline (1.49 +/- 0.93). A statistically significant FVC fade was not present, and a FVC fade of > or =10% was observed in only 2 patients after extubation. Thus, recovery of the TOF ratio to 0.9 predicts with high probability an absence of neuromuscular blocking drug-induced UAO, but outliers, i.e., persistent effects of neuromuscular blockade on upper airway integrity despite recovery of the TOF ratio, may still occur.

Adult↗
PubMed1993

Effect of vecuronium-induced neuromuscular blockade on cortical motor evoked potentials.

BACKGROUND: Neuromuscular blockade (NMB) is a frequent component of anesthetic techniques used during surgery in which monitoring of the nervous system is desirable. Because NMB should affect the evoked muscle response to transcranial magnetic stimulation (tcMMEP), their relationship in a primate model was characterized. METHODS: Transcranial magnetic stimulation was characterized during NMB using an infusion of vecuronium in ten adult cynomologous monkeys during anesthesia with a continuous ketamine infusion. Neuromuscular blockade was measured by peak-to-peak amplitude of the evoked muscular activity (compound muscle action potential [m-response]) of the thenar muscles and mechanical muscle action (ratio of the fourth to first peak in the train of four [TOF]) after direct stimulation of the median nerve. Neuromuscular blockade was increased incrementally to complete block and then allowed to decrease until complete resolution of measurable block. Transcranial magnetic stimulation was assessed by measuring the onset latency (time from stimulation to beginning response) and amplitude of the thenar EMG response. Cortical stimulation was accomplished using a Cadwell MES-10 magnetic stimulator at 80% of full output (1.6 Tesla). RESULTS: The tcMMEP, m-response amplitude, and mechanical muscle action, unblocked, were reduced with increasing NMB. Transcranial magnetic stimulation amplitude was more variable than was onset latency. Transcranial magnetic stimulation amplitude reduction from the baseline value did not achieve statistical significance until the m-response amplitude was reduced to 0.2 of baseline or until the TOF ratio was reduced to 0.1. Transcranial magnetic stimulation onset latency prolongation from baseline was not significantly affected by declining TOF ratios, but was prolonged when the m-response declined to 0.1 of baseline. CONCLUSIONS: This study indicates that tcMMEP onset latency is not significantly affected by NMB if the degree of blockade in the muscles used for tcMMEP monitoring is not extreme (greater than 0.2 of baseline by m-response amplitude or a TOF ratio of 0.1 or greater). If monitoring of tcMMEP amplitude is desired, partial neuromuscular blockade may be acceptable. However, amplitude reduction may occur during partial NMB. Maintenance of a constant degree of NMB is suggested to minimize amplitude fluctuations.

Anesthesia, Inhalation↗
PubMed2000

Residual neuromuscular blockade. Incidence and relevance.

Residual neuromuscular block is a major risk factor behind critical events in the immediate postoperative period. Residual weakness due to muscle relaxants is seen in more than thirds of postoperative patients with ventilatory failure and hypoxia. Residual neuromuscular block should therefore be regarded as a serious adverse event in the same way as we regard ventilatory depression due to opioids and anaesthetic agents. This presentation aim to clarify our present knowledge and shortcomings in the field of residual neuromuscular blockade.

Humans↗
PubMed2006

Reversal of profound rocuronium neuromuscular blockade by sugammadex in anesthetized rhesus monkeys.

BACKGROUND: Reversal of neuromuscular blockade can be accomplished by chemical encapsulation of rocuronium by sugammadex, a synthetic gamma-cyclodextrin derivative. The current study determined the feasibility of reversal of rocuronium-induced profound neuromuscular blockade with sugammadex in the anesthetized rhesus monkey using train-of-four stimulation. METHODS: Four female rhesus monkeys each underwent three experiments. In each experiment, first, a 100-microg/kg dose of rocuronium was injected and spontaneous recovery was monitored. After full recovery, a 500-microg/kg dose of rocuronium was injected. Up to this point, all three experiments in a single monkey were identical. One minute after this rocuronium injection, either one of the two tested dosages of sugammadex (1.0 or 2.5 mg/kg) was injected or saline was injected. RESULTS: Injection of 100 microg/kg rocuronium resulted in a mean neuromuscular blockade of 93.0% (SD = 4%), and profound blockade was achieved by injection of 500 microg/kg. In all experiments, a 100% neuromuscular blockade was achieved at this dose. After injection of the high rocuronium dose, the 90% recovery of the train-of-four ratio took 28 min (SD = 7 min) after saline, 26 min (SD = 9.5 min) after 1 mg/kg sugammadex, and 8 min (SD = 3.6 min) after 2.5 mg/kg sugammadex. Signs of residual blockade or recurarization were not observed. Injection of sugammadex had no significant effects on blood pressure or heart rate. CONCLUSIONS: Chemical encapsulation of rocuronium by sugammadex is a new therapeutic mechanism allowing effective and rapid reversal of profound neuromuscular blockade induced by rocuronium in anesthetized rhesus monkeys.

Androstanols↗
PubMed1991

Interactions of adenosine and vecuronium in neuromuscular blockade in cats.

The effect of adenosine on the neuromuscular blockade induced by vecuronium and the capacity of neostigmine to reverse this combined blockade were studied in 30 cats on a standard sciatic nerve--tibialis anterior muscle preparation. Adenosine infused to 6 cats at a constant rate (3.9 +/- 1.1 mg/kg/min) to produce a stable 50% reduction of the mean arterial pressure did not affect neuromuscular transmission. At the same 50% reduction of the mean arterial pressure by adenosine or sodium nitroprusside infusion in another 15 cats, adenosine (n = 9) significantly potentiated vecuronium-induced neuromuscular blockade, but sodium nitroprusside (n = 6) did not. Neostigmine antagonized the neuromuscular blockade of similar degrees produced either by the combination of adenosine with vecuronium in the above 9 cats or by vecuronium alone in the remaining 9 cats. There was no significant difference in the doses of neostigmine given. Because no potentiation was found at the same level of hypotension induced by sodium nitroprusside, the potentiation effect of adenosine on neuromuscular blockade is not likely to be due to the hypotensive effect of adenosine, but may be due to impairment, by adenosine, of acetylcholine release from motor nerve endings. We conclude that adenosine potentiates neuromuscular blockade by vecuronium and that neostigmine can be expected to reverse this combined blockade.

Adenosine↗
PubMed1999

Marked prolongation of the succinylcholine effect two hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency.

Prolonged neuromuscular blockade from succinylcholine after neostigmine administration has been reported in patients with frank renal failure. We present a case of prolonged neuromuscular blockade from succinylcholine administration, given 2 hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency. This case shows that patients with chronic renal insufficiency, like patients with renal failure, are at risk for prolonged succinylcholine blockade if they have recently received anticholinesterase reversal of neuromuscular blockade. Administration of succinylcholine for facilitation of urgent endotracheal intubation may be required soon after reversal of nondepolarizing muscle relaxants, particularly in patients who return to the operating room for emergency care.

Aged↗
PubMed2003

Comparison between the Datex-Ohmeda M-NMT module and a force-displacement transducer for monitoring neuromuscular blockade.

BACKGROUND AND OBJECTIVE: The Datex-Ohmeda neuromuscular transmission module (M-NMT) is a new monitor that is part of the AS/3 anaesthesia monitor. It incorporates a mechanosensor, which is a piezoelectric polymer attached to the hand. The module was compared with a force transducer in 30 patients requiring neuromuscular blockade. METHODS: Anaesthesia was induced with fentanyl and propofol, and tracheal intubation was performed without muscle relaxants. Neuromuscular blockade was assessed by the test module on one arm and the force transducer on the other arm. When the response to train-of-four stimulation had been stable in both arms for 3 min, rocuronium 0.2 mg kg(-1) was injected intravenously. During recovery from blockade, the train-of-four ratio was measured in 15 patients, and the ratio of response to double-burst stimulation in the other 15 patients. Data analysis was by difference plots. RESULTS: Both devices had acceptable coefficients of repeatability. The M-NMT module was biased by + 1.3% (upper limit of agreement 14.2%, lower limit -12.9%) for the recovery of the train-of-four ratio, and by + 1.09% (17%, -16%) for the recovery of double-burst stimulation ratio. CONCLUSIONS: The Datex-Ohmeda M-NMT gives measurements that are repeatable and gives good enough correspondence with a force transducer that it can be used clinically to assess recovery of neuromuscular blockade, but the limits of agreement rule out research applications.

Androstanols↗
PubMed1995

Facial Nerve Monitoring under Neuromuscular Blockade.

The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.We studied the influence of various levels of neuromuscular blockade on facial nerve stimulation in the New Zealand white rabbit. The facial nerve was exposed in the middle ear of six rabbits. Using electromyographic-type facial nerve monitor, we recorded the facial electromyography signals in these rabbits at increasing levels of vecuronium-induced neuromuscular blockade. All animals demonstrated reliable facial electromyography response at all levels of partial neuromuscular blockade (P < .02). Five of the six animals could be monitored throughout complete blockade. These results clearly demonstrate that rabbit facial electromyography monitoring is possible under neuromuscular blockade. The effect of neuromuscular blockers on facial electromyography monitoring deserves further study, as partial blockade would greatly facilitate the management of anesthesia in otologic, neurotologic, and skull base surgery.

Journal Article↗
PubMed1987

Monitoring neuromuscular blockade with calf stimulators.

The efficacy of monitoring neuromuscular blockade during surgery based on visual assessment of the response to calf stimulation was determined in twenty-five patients. The calf stimulator was adjusted before the administration of any muscle relaxant to produce a brisk ankle jerk. Following an initial bolus dose of atracurium (0.5 mg/kg), further incremental doses (0.2 mg/kg) were administered when the response to calf stimulation was small and obvious. The resultant neuromuscular blockade was judged to be adequate throughout the surgical procedures, with an average of five incremental doses of atracurium being administered. In the presence of neuromuscular blockade the response to calf muscle stimulation was often greater than that produced by supramaximal stimulation of the ulnar nerve with a peripheral nerve stimulator. The response to calf muscle stimulation often persisted after that resulting from ulnar nerve stimulation was abolished. The technique has only limited accuracy in assessing neuromuscular blockade. However, it may be useful in helping to avoid the wide fluctuations in blockade which are prone to occur with the intermediate duration competitive neuromuscular blocking agents.

Adult↗
PubMed2000

The effect of neuromuscular blockade on pedicle screw stimulation thresholds.

STUDY DESIGN: Nerve root stimulation thresholds were studied relative to the level of neuromuscular blockade in patients undergoing lumbar decompression surgery. OBJECTIVES: To determine what levels of intraoperative neuromuscular blockade can be used during pedicle screw stimulation. BACKGROUND DATA: Previous studies of intraoperative pedicle screw stimulation thresholds have failed to determine the effect of neuromuscular blockade on the stimulation threshold. METHODS: Twenty-one roots in 10 patients undergoing lumbar decompression surgery were studied at different levels of neuromuscular blockade. Ninety-five nerve root thresholds were determined relative to level of blockade. RESULTS: Neuromuscular blockade below 80% provides nerve root thresholds similar to thresholds without blockade. CONCLUSIONS: Neuromuscular blockade should be less than 80% when using pedicle screw electrical stimulation testing.

Bone Screws↗
PubMed1991

Effects of residual concentrations of isoflurane on the reversal of vecuronium-induced neuromuscular blockade.

Thirty-six anesthetized patients (ASA physical status 1 or 2) undergoing elective surgery were monitored (isometric adductor pollicis mechanical activity) to detect the effects of discontinuing isoflurane anesthesia upon the reversal of vecuronium-induced neuromuscular blockade. Neuromuscular blockade was produced by vecuronium 100 micrograms/kg and additional doses of 20 micrograms/kg until completion of surgery. The patients were randomly divided into three groups: in the control group (n = 12), only fentanyl/N2O was given; in the "isostable" group (n = 12), isoflurane at an end-tidal concentration of 1.25% was maintained throughout anesthesia; in the "isostop" group (n = 12), isoflurane 1.25% was discontinued before neostigmine administration. In all groups, paralysis was antagonized with 15 micrograms/kg intravenous (iv) atropine and 40 micrograms/kg iv neostigmine when the twitch height (0.1 Hz) had regained 25% of its control value. The measured parameters were twitch height, train-of-four, and 50--100-Hz tetanic fade. No significant differences were found among the three groups with respect to the final twitch heights and tetanic fades at 50 Hz. In the isostable group, final mean train-of-four was significantly less (75%) than in the other patients (88%) (P less than 0.01). Mean tetanic fade at 100 Hz was significantly less in the isostable group (31%) than in the isostop group (57%) (P less than 0.01) and control group (84%) (P less than 0.01). We conclude that discontinuing isoflurane anesthesia for 15 min improves the reversal of a vecuronium paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Decrease of functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized young infants and preschool children.

BACKGROUND: Based on age-dependent differences in pulmonary mechanics, the effect of neuromuscular blockade may differ in infants compared with older children. The aim of this study was to determine the impact of neuromuscular blockade and its reversal by positive end-expiratory pressure (PEEP) on functional residual capacity (FRC) and ventilation distribution in young infants and preschool children. METHODS: The authors studied 14 infants (aged 0-6 months) and 25 preschool children (aged 2-6 yr). FRC and lung clearance index were calculated. Measurements were taken (1) after intubation, (2) during neuromuscular blockade, and (3) during neuromuscular blockade plus application of PEEP (3 cm H2O). RESULTS: Functional residual capacity (mean +/- SD) decreased from 21.3 +/- 4.7 ml/kg to 12.2 +/- 4.8 ml/kg (P < 0.001) during neuromuscular blockade in infants and from 25.6 +/- 5.9 ml/kg to 23.0 +/- 5.3 ml/kg (P < 0.001) in preschool children. With the application of PEEP, FRC increased to 22.3 +/- 5.9 ml/kg (P = 0.4829, compared with baseline) in infants and 28.2 +/- 5.8 ml/kg (P < 0.001) in children. The lung clearance index increased after neuromuscular blockade, whereas baseline values were regained after the application of PEEP. The changes induced by neuromuscular blockade were significantly greater in infants compared with preschool children (P < 0.001). CONCLUSIONS: Although the use of neuromuscular blockade decreased FRC and ventilation distribution substantially in both groups, the changes were more pronounced in young infants. With PEEP, FRC increased and ventilation homogeneity was restored. These results provide a rationale to use PEEP in anesthetized, paralyzed infants and children.

Anesthesia↗
PubMed2003

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

PURPOSE: To review recent findings concerning neuromuscular blockade and monitoring at the larynx, the diaphragm, and the corrugator supercilii muscle. SOURCE: This narrative review is based on recent publications. PRINCIPAL FINDINGS: 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. CONCLUSION: 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.

Diaphragm↗
PubMed1986

Edrophonium antagonizes combined lidocaine-pancuronium and verapamil-pancuronium neuromuscular blockade in cats.

The effects of lidocaine or verapamil on pancuronium neuromuscular blockade and the ability of anticholinesterase agents to antagonize these combined blockades were studied in 14 cats using a standard peroneal nerve-anterior tibialis muscle preparation. Pancuronium was infused at a constant rate to produce a stable 50% depression of single twitch tension. In nine cats, intravenous lidocaine boluses followed by a constant infusion produced serum lidocaine levels of 5.09 +/- 1.9 micrograms/ml (mean +/- SD) and resulted in an additional 20.0 +/- 5.5% depression of twitch tension. In the other five cats, intravenous injection of 0.15 mg/kg of verapamil produced an additional 12.8 +/- 8.0% twitch depression of pancuronium-induced neuromuscular blockade. For individual animals, edrophonium antagonism of the combined lidocaine-pancuronium-induced neuromuscular blockade or combined verapamil-pancuronium-induced neuromuscular blockade was not significantly different from antagonism of an equivalent twitch depression produced by pancuronium alone. It is concluded that lidocaine and verapamil augment neuromuscular blockade caused by pancuronium and that anticholinesterase antagonism of this augmented blockade can be expected to occur in a normal fashion.

Animals↗
PubMedDate not supplied

Cardiovascular responses to neuromuscular blockade in the anemic ovine fetus.

Currently little is known about the cardiovascular responses of the anemic fetus to neuromuscular blockade. We hypothesized that, despite marked anemia with potentially decreased cardiac reserve, the fetal responses to Pancuronium neuromuscular blockade would differ significantly when compared with neuromuscular blockade with Atracurium (a cardiovascular sparing agent). Ten fetal sheep (137 +/- 1 (SE) days gestation) were divided into three groups (21 experiments): Pancuronium (n = 7), Atracurium (n = 6), and Control (n = 8). Fetal anemia (Hct = 21.8 +/- 0.7%) was produced by serial hemorrhage over 3 days. Fetal arterial (FAP) and venous (FVP) pressures, heart rate (FHR), and arterial pH, pO2, and pCO2 were measured at -20, 0, 10, 20, 30, 60, and 90 minutes relative to neuromuscular blockade. Data were analyzed by three-way ANOVA for repeated measures. Pancuronium neuromuscular blockade increased FHR (15-20 bpm, P < .0001) and decreased FVP (-0.8 mm Hg, P < .0001). Atracurium had no effect on FHR, FAP, or FVP. Fetal pH (0.024, P < .0001) and pO2 (1-2 mm Hg, P = .0001) increased in both neuromuscular-blocked groups. Fetal pCO2 decreased in the Pancuronium-blocked animals (P = .02). We conclude that, in anemic fetuses, neuromuscular blockade with Atracurium produced minimal cardiovascular effects when compared to neuromuscular blockade with Pancuronium. Both agents produced small improvements in fetal pH and blood gases.

Analysis of Variance↗
PubMed2003

The relationship of posttetanic count and train-of-four responses during recovery from intense cisatracurium-induced neuromuscular blockade.

UNLABELLED: Posttetanic count (PTC) has been used to quantify intense degrees of nondepolarizing neuromuscular blockade. Our objective in the present investigation was to discern whether PTC correlates with recovery from intense cisatracurium-induced neuromuscular blockade under both inhaled and IV anesthesia. In 60 patients, anesthesia was induced with propofol 2 mg/kg and fentanyl 1.5 micro g/kg IV. Recovery from intense neuromuscular blockade induced by cisatracurium (0.15 mg/kg) was studied in 2 groups. Group 1 (n = 30) had anesthesia maintained with propofol 100-200 micro g x kg(-1) x min(-1) and 60% N(2)O in O(2), whereas Group 2 (n = 30) had anesthesia maintained with isoflurane (end-tidal concentration 0.8%) and 60% N(2)O in O(2). Neuromuscular functions were monitored using acceleromyography. Cycles of posttetanic stimulation were repeated every 6 min with train-of-four (TOF) stimulation in between. Measurement included times to posttetanic responses and to the first response to TOF stimulation (T(1)), as well as the correlation between PTC and T(1). In Group 1, the mean times to PTC(1) and T(1) were 35.6 +/- 7.5 and 46.9 +/- 6.5 min, respectively. Corresponding times in Group 2 were 39.5 +/- 6.8 and 56.7 +/- 5.4 min, respectively. There was a good time correlation, r = 0.919 for propofol (Group 1) and r = 0.779 for isoflurane (Group 2), between PTC and T(1) recovery in both groups. The PTC when T(1) appeared ranged between 8 and 9 in Group 1 and 8 and 14 in Group 2. Conforming to original observations with other neuromuscular blocking drugs, there is a correlation between PTC and TOF recovery from intense cisatracurium-induced neuromuscular blockade allowing better monitoring of this intense degree of blockade during both IV (propofol) and isoflurane anesthesia. IMPLICATIONS: Monitoring posttetanic count during intense neuromuscular blockade allows the clinician to estimate the intensity of the blockade and estimate recovery time. The relationship between posttetanic count and train-of-four recovery from intense cisatracurium-induced neuromuscular blockade was documented under both IV and inhaled anesthesia.

Adult↗