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A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles

  • Joachim Schmidt
  • Andrea Irouschek
  • Tino Muenster
  • Thomas M. Hemmerling
  • Sven Albrecht
General Anesthesia

Abstract

Purpose

Priming is a known technique to accelerate onset of neuromuscular blockade (NMB). Its effect on NMB of the larynx has not been studied yet.

Methods

We compared a priming technique with a bolus application of rocuronium on the onset of NMB at the laryngeal adductor and the adductor pollicis muscles (AP). In 30 female patients, after induction of anesthesia a tube with a surface electrode was placed into the trachea prior to the administration of any neuromuscular blocking agent to monitor electromyography (EMG) of the laryngeal adductor muscles. Neuromuscular monitoring consisted of EMG of the laryngeal adductor muscles and the left AR Patients were randomized into two groups. After transcutaneous stimulation of the recurrent laryngeal nerve and ulnar nerve, a bolus of rocuronium 0.6 mg·kg−1 (Bolus group) or a priming dose of rocuronium 0.06 mg·kg−1 followed by rocuronium 0.54 mg·kg−1 three minutes later (Priming group) were injected. Lag time, onset 90%, onset time and peak effect of NMB were recorded and compared; aP < 0.05 was considered significant.

Results

The onset 90% and onset time measured at the laryngeal adductor muscles (onset: 44.7 ± 7.4vs 74.0 ± 23.8 sec) and at the AP (onset: 105.4 ± 29.9vs 139.2 ±51.5 sec) were significantly shorter in the Priming group than in the Bolus group. Within groups, the onset times were significantly shorter at the laryngeal muscles in comparison to AR

Conclusion

Our results indicate that a priming technique with rocuronium significantly accelerates the onset of NMB at the laryngeal adductor muscles. Our results further support the use of rocuronium as an alternative to succinylcholine for rapid sequence induction.

Keywords

Onset Time Recurrent Laryngeal Nerve Succinylcholine Rocuronium Neuromuscular Blockade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Une technique d’amorçage accélère le blocage neuromusculaire au niveau des muscles adducteurs du larynx

Résumé

Objectif

Lamorçage est une technique connue pour accélérer l’installation du blocage neuromusculaire (BNM). Son effet sur le BNM du larynx n’a pas encore été étudié.

Méthode

Nous avons comparé une technique d’amorçage et l’injection de bolus de rocuronium au début du BNM de l’adducteur du larynx et de l’adducteur du pouce (AP). Après l’induction de l’anesthésie chez 30 patientes, un tube muni d’une électrode superficielle a été placé dans la trachée avant l’administration d’agent myorelaxant pour permettre le monitorage électromyographique (EMG) des muscles adducteurs du larynx. Le monitorage de la transmission neuromusculaire consistait à l’EMG des muscles adducteurs du larynx et de l’AP gauche. Les patientes ont été réparties aléatoirement en deux groupes. Après la stimulation transcutanée du nerf laryngé récurrent et des nerfs cubitals, un bolus de rocuronium de 0,6 mg·kg−1 (groupe Bolus) ou une dose d’amorçage de 0,06 mg·kg−1 de rocuronium suivis de 0,54 mg·kg−1 de rocuronium trois minutes plus tard (groupe Amorçage) ont été injectés. La période latence, le moment où le bloc est installé à 90 %, le délai d’installation et le moment de l’effet maximal du BNM ont été notés et comparés; un P < 0,05 était considéré significatif.

Résultats

Le bloc neuromusculaire à 90 % et le délai d’installation mesurés aux adducteurs du larynx (début: 44,7 ± 7,4 vs 74,0 ± 23,8 sec) et à l’AP (début: 105,4 ± 29,9 vs 139,2 ± 51,5 sec) ont été signifcativement plus courts dans le groupe Amorçage que dans le groupe Bolus. A l’intérieur des groupes, les délais d’installation du bloc ont été significativement plus courts aux muscles laryngés qu’à l’AP.

Conclusion

Une technique d’amorçage avec du rocuronium accélère de façon significative l’installation du BNM aux muscles adducteurs du larynx. De plus, nos résultats sont en faveur de l’usage de rocuronium pour remplacer la succinylcholine dans l’induction en séquence rapide.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Joachim Schmidt
    • 1
  • Andrea Irouschek
    • 1
  • Tino Muenster
    • 1
  • Thomas M. Hemmerling
    • 2
  • Sven Albrecht
    • 1
  1. 1.Department of AnesthesiologyUniversity of Erlangen-NurembergErlangenGermany
  2. 2.Department of AnesthesiologyCentre Hospitalier de l’Université de MontréalMontrealCanada

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