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Clinical, electrical and mechanical correlations during recovery from neuromuscular blockade with vecuronium

Abstract

In order to détérmine correlations between electromyographic (EMG), mecanomyographic (MMG) and clinical criteria of adequate recovery from neuromuscular blockade with vecuronium, seven young healthy conscious volunteers were given subparalysing doses of vecuronium. During recovery from neuromuscular blockade, vital capacity, negative inspiratory pressure, peak expiratory flow rate and five-second head lift were assessed. Neuromuscular monitoring included the evoked EMG response of the adductor digiti minimi and the simultaneous evoked MMG response of the adductor pollicis on the same side. We found that all subjects maintained head lift for five seconds at EMG T4T1 of 0.70, and they achieved normal respiratory tests at EMG T4/T1 of 0.90. The MMG T4/T1 needed for the subjects to perform normal respiratory tests was found to be 0.50, at which time six of the seven subjects were able to perform adequately the head lift test.

Résumé

La correlation entre l’électromyographie (EMG), la mécano-myographie (MMG) et des critères cliniques de récuperation adéquate suite à l’administration de doses sous-paralytisantes de vécuronium a été étudiée chez sept jeunes volontaires sains. Pendant la phase de récupération du bloc neuromusculaire, la capacité vitale, la force inspiratoire, le débit expiratoire de pointe et la capacité de maintien de la tête soulevée pour cinq secondes ont été évalués. Le monitorage neuromusculaire comprenait au niveau d’un même membre supérieur un EMG de l’adductor digiti minimi et un MMG de l’adductor pollicis. En ce qui a trait à l’EMG, tous les sujets ont réussi l’épreuve du maintien de la tête soulevée pour cinq secondes lorsque le rapport T4/T1 était de 0,70 et les tests de fonction respiratoire se sont avérés dans les limites normales lorsque le rapport T4/T1 était revenu à 0,90. Quant au MMG, six des sept sujets ont réussi le test du maintien de la tête soulevée pour cinq secondes lorsque le rapport T4/T1 etait de 0,50, alors que tous les tests de fonction respiratoire étaient revenus à la normale à ce momentlà.

References

  1. 1

    Ali HH, Savarese JJ. Monitoring of neuromuscular function. Anesthesiology 1976; 45: 216–48.

  2. 2

    Kopman AF. The relationship of evoked electromyographic and mechanical responses following atracurium in humans. Anesthesiology 1985; 63: 208–11.

  3. 3

    Weber S, Muravchick S. Electrical and mechanical train-of-four responses during depolarizing and nondepolarizing neuromuscular blockade. Anesth Analg 1986; 65: 771–6.

  4. 4

    Johansen SH, Jorgensen M, Molbech S. Effect of tubo-curarine on respiratory and nonrespiratory muscle power in man. J Appl Physiol 1964; 19: 990–4.

  5. 5

    Walts LF, Levin N, Dillon JB. Assessment of recovery from curare. JAMA 1970; 213: 1894–6.

  6. 6

    Ali HH, Kitz RJ. Evaluation of recovery from nondepolarizing neuromuscular block, using a digital neuromuscular transmission analyzer: preliminary report. Anesth Analg 1973; 52: 740–4.

  7. 7

    Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth 1975; 47: 570–4.

  8. 8

    Brand JB, Cullen DJ, Wilson NE, Ali HH. Spontaneous recovery from nondepolarizing neuromuscular blockade: correlation between clinical and evoked response. Anesth Analg 1977: 56: 55–8.

  9. 9

    Ali HH. Monitoring neuromuscular function. Anesthesiology 1986; 64: 532.

  10. 10

    Jones RM, Pearce AC, Williams JP. Recovery characteristics following antagonism of atracurium with neostigmine or edrophonium. Br J Anaesth 1984; 56: 453–7.

  11. 11

    Sharpe MJ, Lam AM, Nicholas JF, Chung DC, Merchant R, Alyafi W. Correlation between integrated evoked EMG and respiratory function following atracurium administration. Can J Anaesth 1987; 34: S77–8.

  12. 12

    Foldes FF, Monte AP, Brunn HM, Wolfson B. Studies with muscle relaxants in unanesthetized subjects. Anesthesiology 1961; 22: 230–6.

  13. 13

    Miller RD. Antagonism of neuromuscular blockade. Anesthesiology 1976; 44: 318–29.

  14. 14

    Viby-Mogensen J, Jensen NH, Engbaek J, Ording H, Skovgaard LT, Chraemmer-Jorgensen B. Tactile and visual evaluation of the response to train-of-four nerve stimulation. Anesthesiology 1985; 63: 440–3.

  15. 15

    Forbes AR, Cohen NH, Eger EI. Pancuronium reduces halothane requirement in man. Anesth Analg 1979; 58: 497–9.

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Correspondence to R. Martin.

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Dupuis, J.Y., Martin, R. & Tétrault, J.P. Clinical, electrical and mechanical correlations during recovery from neuromuscular blockade with vecuronium. Can J Anaesth 37, 192–196 (1990). https://doi.org/10.1007/BF03005468

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Key words

  • measurement techniques: electromyography, neuromuscular blockade, respiratory function
  • monitoring: neuromuscular function
  • neuromuscular relaxants: vecuronium
  • measurement of response