scholarly journals EVOKED ELECTROMYOGRAPHIC AND MECHANICAL RESPONSES OF THE ADDUCTOR POLLICIS COMPARED DURING THE ONSET OF NEUROMUSCULAR BLOCKADE BY ATRACURIUM OR ALCURONIUM, AND DURING ANTAGONISM BY NEOSTIGMINE

1986 ◽  
Vol 58 (11) ◽  
pp. 1278-1284 ◽  
Author(s):  
N.J.N. HARPER ◽  
E.G. BRADSHAW ◽  
T.E.J. HEALY
Keyword(s):  
Neuromuscular Blockade ◽  
Adductor Pollicis ◽  
Mechanical Responses

scholarly journals A comparison between the flexor hallucis brevis and adductor pollicis muscles in atracurium-induced neuromuscular blockade using acceleromyography

2020 ◽  
Vol 37 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Maëlle Le Merrer ◽  
Denis Frasca ◽  
Maxime Dupuis ◽  
Bertrand Debaene ◽  
Matthieu Boisson
Keyword(s):  
Neuromuscular Blockade ◽  
Adductor Pollicis

Are Plasma Concentration Values Necessary for Pharmacodynamic Modeling of Muscle Relaxants?

1997 ◽  
Vol 86 (3) ◽  
pp. 567-575 ◽  
Author(s):  
Dennis M. Fisher ◽  
Peter M. C. Wright
Keyword(s):  
Plasma Concentration ◽  
Traditional Approach ◽  
Muscle Relaxants ◽  
Adductor Pollicis ◽  
Pharmacodynamic Modeling ◽  
Concentration Data ◽  
Mechanical Responses ◽  
Drug Concentrations ◽  
Train Of Four ◽  
The Hill

Background The traditional approach to pharmacokinetic/ pharmacodynamic modeling of muscle relaxants requires sampling of plasma to determine drug concentrations. The authors recently proposed that certain pharmacodynamic characteristics (IR50, the steady-state infusion rate to maintain 50% twitch depression; keo, the rate constant for equilibration between plasma concentration and effect; and gamma, the Hill factor describing sigmoidicity of the concentration-effect relation) could be estimated without plasma concentration data. Here estimates for IR50, keo, and gamma determined with and without plasma concentration data are compared. Methods Six volunteers were given 15-60 micrograms/kg vecuronium on each of two occasions during anesthesia with propofol. Mechanical responses to train-of-four stimulation were measured at the adductor pollicis and at the laryngeal adductors. Various pharmacokinetic models accounting for the presence and potency of vecuronium's 3-desacetyl metabolite and a sigmoid e-max pharmacodynamic model were fit to the resulting plasma concentration and effect (adductor pollicis and laryngeal adductors) data to determine IR50 keo, and gamma for each effect. One model related dose to effect without plasma concentration data. Results Values for IR50(adductor pollicis), IR50(laryngeal adductors), gamma (adductor pollicis), and gamma (laryngeal adductors) were similar when determined with and without plasma concentration values. Values for keo (adductor pollicis) and keo (laryngeal adductors) were larger when determined without plasma concentration values compared with those determined with these values; however, the ratio of keo (adductor pollicis) to keo(laryngeal adductors) was similar when determined with and without plasma concentration values. Conclusions Certain pharmacodynamic parameters were estimated accurately in the absence of plasma concentration values. This suggests limited utility for plasma concentration data under conditions similar to those of the present study.

Neuromuscular Monitoring at the Orbicularis Oculi May Overestimate the Blockade in Myasthenic Patients

2000 ◽  
Vol 93 (5) ◽  
pp. 1194-1197 ◽  
Author(s):  
Hironori Itoh ◽  
Keizo Shibata ◽  
Masahiro Yoshida ◽  
Ken Yamamoto
Keyword(s):  
Nitrous Oxide ◽  
Facial Nerve ◽  
Myasthenia Gravis ◽  
Neuromuscular Blockade ◽  
Ulnar Nerve ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Neuromuscular Monitoring ◽  
Adductor Pollicis ◽  
Orbicularis Oculi

Background In most publications about myasthenia, monitoring neuromuscular blockade during anesthesia is recommended. In healthy patients, the relation of blockade between muscles has been established, but there is little information about the relation in myasthenic patients. Our objective was to investigate whether the relation between the orbicularis oculi and adductor pollicis muscles is the same in healthy patients and myasthenic patients. Methods After anesthesia was induced with 4-6 mg/kg thiopental and 2 microg/kg fentanyl, followed by 2% sevoflurane and 60% nitrous oxide in oxygen, 10 healthy patients and 10 myasthenic patients received 0. 025 and 0.01 mg/kg vecuronium, respectively. Neuromuscular monitoring was performed with use of accelerometry at the orbicularis oculi and the adductor pollicis muscles by stimulating the temporal branch of the facial nerve and the ulnar nerve. Results The relation of blockade between these two muscles was not the same in healthy patients and myasthenic patients: in healthy patients, the maximum neuromuscular blockade with 0.025 mg/kg vecuronium was less in the orbicularis oculi than in the adductor pollicis (median 72% vs. 91%; P < 0.05); in contrast, in myasthenic patients, the blockade with 0.01 mg/kg vecuronium was greater in the orbicularis oculi than in the adductor pollicis (median 96% vs. 62%; P < 0.05). Conclusion Neuromuscular monitoring at the orbicularis oculi may overestimate blockade in myasthenic patients. Extubation must be performed when the muscle most sensitive to neuromuscular blocking agents is recovered. Therefore, neuromuscular monitoring at the orbicularis oculi is recommended to avoid persistent neuromuscular blockade in patients with myasthenia gravis.

scholarly journals Sevoflurane Induction Shortens the Onset of Vecuronium at the Corrugator Supercilii Muscles: A Randomized Comparison with Propofol Induction

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Keiichi Nitahara ◽  
Yasuyuki Sugi ◽  
Go Kusumoto ◽  
Kiyoshi Katori ◽  
Kohei Iwashita ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Time Course ◽  
Onset Time ◽  
Adductor Pollicis ◽  
Evoked Responses ◽  
Similar Time ◽  
Laryngeal Muscles ◽  
Sevoflurane Group ◽  
Corrugator Supercilii ◽  
Train Of Four

We evaluated if induction with sevoflurane shortened the onset of vecuronium-induced neuromuscular blockade at the corrugator supercilii muscles (which have a similar time course of neuromuscular blockade with laryngeal muscles). Thirty-two patients were randomly allocated to a sevoflurane or propofol group. Anesthesia was induced with 5% sevoflurane in oxygen (sevoflurane group, n=16) or with propofol 2–2.5 mg kg−1(propofol group, n=16), and vecuronium (0.1 mg kg−1) was given in both groups. Evoked responses to train-of-four stimuli were measured by acceleromyography at the corrugator supercilii and adductor pollicis muscles. Sevoflurane induction, as compared with propofol, significantly shortened the onset time at the corrugator supercilii muscles from 138 ± 34 s to 107 ± 28 s (P<0.01). Onset time at the corrugator supercilii was significantly shorter than at the adductor pollicis for both groups (P<0.01). Our results suggest that induction with sevoflurane, as compared with propofol, shortened the onset time of vecuronium at laryngeal muscles.

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