Comparison of tactile and mechanomyo-graphical assessment of response to double burst and train-of-four stimulation during moderate and profound neuromuscular blockade
| Autor: | Michael Braüner Schmidt, Peter Lindholm, Inge Krogh Severinsen, Henrik Stougaard Pedersen, Hans Kirkegaard-Nielsen, H. S. Helbo‐Hansen |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Adult
Adolescent Transducers Neuromuscular Junction Neuromuscular transmission Stimulation Anesthesia General Atracurium besilate Humans Medicine Single-Blind Method Ulnar Nerve Nurse Anesthetists Laparotomy Neuromuscular Blockade business.industry Signal Processing Computer-Assisted Genitalia Female General Medicine Nurse anesthetist Middle Aged Neuromuscular monitoring Electric Stimulation Adductor pollicis muscle Blockade Anesthesiology and Pain Medicine Touch Anesthesia Anesthesia Recovery Period Atracurium Female business business.employer Muscle Contraction medicine.drug |
| Zdroj: | Canadian Journal of Anaesthesia. 42:21-27 |
| ISSN: | 1496-8975 0832-610X |
| Popis: | It is common clinical practice to estimate the degree of neuromuscular blockade by tactile evaluation of twitch responses. The aim of the present study was to evaluate the use of tactile responses of adductor pollicis to double-burst stimulation (DBS) and train-of-four (TOF) peripheral nerve stimulation for monitoring moderate and profound levels of neuromuscular blockade. The study comprised 44 women scheduled for gynaecological laparotomy and anaesthetised with midazolam, fentanyl, thiopentone, halothane, nitrous oxide and atracurium. The tactile responses of the adductor pollicis were compared with mechanomyographical measurements in the contra lateral arm during recovery from neuromuscular blockade. The observers (anaesthetic nurses) of the tactile responses were blinded with regard to the stimulation pattern and the mechanomyo-graphical measurements. The time from injection of the initial dose of atracurium until tactile reappearance of the first twitch in DBS (D1), was 24.6 (0–39.8) min, median (range). This was more rapid than the time until tactile reappearance of the first twitch in TOF (T1) 32.8 (18.–243.4) min (P< 0.05). The median time from tactile reappearance of D1 until T1 recovered to 15% of the control twitch height was longer than the median time from tactile reappearance of T1 (14.6 versus 10.5 min) (P < 0.05). One or two responses to DBS or TOF were often felt before any responses had been detected mechanomyographically in the contralateral arm. When three or four responses to TOF were felt, responses were always detected mechanomyographically. It is concluded that tactile evaluation of responses to DBS stimulation can estimate deeper levels of blockade than tactile evaluation of responses to TOF. |
| Databáze: | OpenAIRE |
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