Train-of-Four Stimulation for Adductor Pollicis Neuromuscular Monitoring Can Be Applied at the Wrist or Over the Hand

2005 ◽  
Vol 100 (1) ◽  
pp. 149-154 ◽  
Author(s):  
Marie-Eve Nepveu ◽  
Fran??ois Donati ◽  
Louis-Philippe Fortier
Keyword(s):  
Neuromuscular Monitoring ◽  
Adductor Pollicis ◽  
Train Of Four

Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function

2018 ◽  
Vol 129 (5) ◽  
pp. 880-888 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Torin D. Shear ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Spontaneous Recovery ◽  
Three Dimensional ◽  
Tracheal Extubation ◽  
Neuromuscular Function ◽  
Neuromuscular Monitoring ◽  
Limits Of Agreement ◽  
Train Of Four ◽  
Good Agreement

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyography device that measures movement of the thumb in multiple planes. The aim of this observational investigation was to assess the agreement between nonnormalized and normalized train-of-four values obtained with the TOF-Watch SX (Organon, Ireland) and those obtained with the TOFscan during recovery from neuromuscular blockade. Methods Twenty-five patients were administered rocuronium, and spontaneous recovery of neuromuscular blockade was allowed to occur. The TOFscan and TOF-Watch SX devices were applied to opposite arms. A preload was applied to the TOF-Watch SX, and calibration was performed before rocuronium administration. Both devices were activated, and train-of-four values were obtained every 15 s. Modified Bland–Altman analyses were conducted to compare train-of-four ratios measured with the TOFscan to those measured with the TOF-Watch SX (when train-of-four thresholds of 0.2 to 1.0 were achieved). Results Bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at nonnormalized train-of-four ratios between 0.2 and 1.0 were 0.021 and −0.100 to 0.141, respectively. When train-of-four measures with the TOF-Watch SX were normalized, bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at ratios between 0.2 and 1.0 were 0.015 and −0.097 to 0.126, respectively. Conclusions Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery.

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.

The Corrugator Supercilii, Not the Orbicularis Oculi, Reflects Rocuronium Meeting Abstracts at the Laryngeal Adductor Muscles

2001 ◽  
Vol 95 (1) ◽  
pp. 96-101 ◽  
Author(s):  
Benoît Plaud ◽  
Bertrand Debaene ◽  
François Donati
Keyword(s):  
Neuromuscular Blocking ◽  
Adductor Pollicis ◽  
Orbicularis Oculi ◽  
Institutional Approval ◽  
Laryngeal Muscles ◽  
Neuromuscular Blocking Drugs ◽  
Corrugator Supercilii ◽  
Adductor Muscles ◽  
Train Of Four ◽  
Oxide Anesthesia

Background Some studies suggest that the orbicularis oculi is resistant to neuromuscular blocking drugs and behaves like laryngeal muscles. Others report little or no difference between the orbicularis oculi and the adductor pollicis. These discrepancies could be related to the exact site of recording. The purpose of this study was to compare two monitoring sites around the eye with the adductor pollicis and the laryngeal adductor muscles. Methods After institutional approval and informed consent, the evoked response to train-of-four stimulation was measured in 12 patients by acceleromyography at the thumb (adductor pollicis), the eyelid (orbicularis oculi), and the superciliary arch (corrugator supercilii) after 0.5 mg/kg rocuronium during propofol-fentanyl-nitrous oxide anesthesia. In 12 other patients, laryngeal adductor neuromuscular blockade was assessed via the cuff of the tracheal tube and compared with the adductor pollicis and the corrugator supercilii after 0.6 mg/kg rocuronium. Results After 0.5 mg/kg, maximum blockade (%T1, mean +/- SD) was less at the corrugator supercilii (80+/-20%) than at the adductor pollicis (100+/-1%) and the orbicularis oculi (93+/-8%) (P < 0.01). Clinical duration (25%T1) was shorter at the corrugator supercilii (12+/-7 min) than at the adductor pollicis (25+/-4 min) and orbicularis oculi (24+/-10 min) (P < 0.01). After 0.6 mg/kg, maximum blockade was similar at the corrugator supercilii (88+/-8%) and the laryngeal adductor muscles (89+/-11%). Clinical duration at the corrugator supercilii and the laryngeal adductors was 17+/-7 and 17+/-10 min, respectively. Conclusions Muscles around the eye vary in their response to rocuronium. The response of the superciliary arch (corrugator supercilii) reflects blockade of laryngeal adductor muscles. However, the eyelid (orbicularis oculi) and thumb (adductor pollicis) have similar sensitivities.

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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