Die Muskelrelaxanzien sind neben den Inhalationsanästhetika, den Hypnotika und den Opiaten die am häufigsten benutzten Medikamente bei der Allgemeinanästhesie. Während zur quantitativen Ermittlung der Anästhesietiefe aufwendige und wenig verläßliche Apparaturen notwendig sind, ist die Quantifizierung der Muskelrelaxation mit einfachen und billigen Methoden möglich und sollte deshalb zum Standard der apparativen Überwachung der Allgemeinanästhesie gehören.


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  1. 1.
    Ali HH, Wilson RS, Savarese JJ, Kitz RI (1975) The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth 47:570–574CrossRefPubMedGoogle Scholar
  2. 2.
    Ali HH, Savarese JJ (1976) Monitoring of neuromuscular function. Anesthesiology 45: 216–249CrossRefPubMedGoogle Scholar
  3. 3.
    Ali HH, Savarese JJ (1980) Stimulus frequency and the dose response curve to dtubocurarine in man. Anesthesiology 52: 36–39CrossRefPubMedGoogle Scholar
  4. 4.
    Ausems ME, Hug CC, Stanski DR, Burm AGL (1986) Plasma concentrations of alfentanil required to supplement nitrous oxide anesthesia for general surgery. Anesthesiology 65:362–373CrossRefPubMedGoogle Scholar
  5. 5.
    Azar I (1984) The response of patients with neuromuscular disorders to muscle relaxants: a review. Anesthesiology 61:173–187CrossRefPubMedGoogle Scholar
  6. 6.
    Baraka A, Tabboush Z (1991) Neuromuscular response to succinylcholine-vecuronium sequence in three myasthenic patients undergoing thymectomy Anesth Analg 72: 827–830PubMedGoogle Scholar
  7. 7.
    Baurain MJ, d’Hollander AA, Melot C, Dernovoi BS, Barvais L (1991) Effects of residual concentration of isoflurane on the reversal of vecuronium-induced neuromuscular blockade. Anesthesiology 74:474–478CrossRefPubMedGoogle Scholar
  8. 8.
    Beemer GH, Bjorksten AR, Crankshaw DP (1993) Effect of body build on the clearance of atracurium: implication for drug dosing. Anesth Analg 76:1296–1303PubMedGoogle Scholar
  9. 9.
    Beemer GH, Reeves JH (1988) An evaluation of eight peripheral nerve stimulators for monitoring neuromuscular blockade. Anaesth Intensive Care 16:464–477PubMedGoogle Scholar
  10. 10.
    Beemer GH, Reeves JH, Bjorksten AR (1990) Accurate monitoring of neuromuscular blockade using a peripheral nerve stimulator — a review. Anaesth Intensive Care 18: 490–496PubMedGoogle Scholar
  11. 11.
    Berger JJ, Gravenstein JS, Munson ES (1982) Electrode polarity and peripheral nerve stimulation. Anesthesiology 56:402–404CrossRefPubMedGoogle Scholar
  12. 12.
    Bevan DR, Donati F, Kopman AF (1992) Reversal of neuromuscular blockade. Anesthesiology 77:785–805CrossRefPubMedGoogle Scholar
  13. 13.
    Bevan DR, Smith CE, Donati F (1988) Postoperative neuromuscular blockade: a comparison between atracurium, vecuronium, and pancuronium. Anesthesiology 69: 272–276CrossRefPubMedGoogle Scholar
  14. 14.
    Brull SJ, Connelly NR, Silverman DG (1990) Correlation of train-of-four and double burst stimulation ratios at varying amperages. Anesth Analg 71:489–492CrossRefPubMedGoogle Scholar
  15. 15.
    Brull S J, Ehrenwerth J, Connelly NR, Silverman DG (1991) Assessment of residual curarization using low current stimulation. Can J Anaesth 38:164–168CrossRefPubMedGoogle Scholar
  16. 16.
    Buchthal F, Schmalbruch H (1980) Motor unit of mammalian muscle. Physiol Rev 60: 90–142PubMedGoogle Scholar
  17. 17.
    Caffrey RR, Warren ML, Becker KE (1986) Neuromuscular monitoring comparing the orbicularis oculi and adductor pollicis muscles. Anesthesiology 65:95–97CrossRefPubMedGoogle Scholar
  18. 18.
    Coakley JH, Nagendran K, Honavar M, Hinds CJ (1993) Preliminary observations on the neuromuscular abnormalities in patients with organ failure and sepsis. Intensive Care Med 19:323–328CrossRefPubMedGoogle Scholar
  19. 19.
    Donati F, Meistelmann C, Plaud B (1990) Vecuronium neuromuscular blockade at the diaphragm, the orbicularis oculi, and adductor pollicis muscles. Anesthesiology 73: 870–875CrossRefPubMedGoogle Scholar
  20. 20.
    Donati F, Meistelmann C, Plaud B (1991) Vecuronium neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology 74:833–837CrossRefPubMedGoogle Scholar
  21. 21.
    Drenck NE, Ueda N, Olsen NV, Engbaek J, Jensen E, Skovgaard LT, Viby-Mogensen J (1989) Manual evaluation of residual curarization using double burst stimulation: A comparison with train-of-four. Anesthesiology 70:578–581CrossRefPubMedGoogle Scholar
  22. 22.
    Engbaek J, Oestergaard D, Viby-Mogensen J, Skovgaard LT (1989) Clinical recovery and train-of-four ratio measured mechanically and electromyographically following atracurium. Anesthesiology 71:391–395CrossRefPubMedGoogle Scholar
  23. 23.
    Ensalada LM, Muravchick S, Weber S, Rosato EF, Defeo SP (1986) Isoflurane reduces abdominal wall tension independent of its effect on neuromuscular blockade. Anesthesiology 65: A3 (Suppl)CrossRefGoogle Scholar
  24. 24.
    Epstein RA, Epstein RM (1973) The electromyogram and the mechanical response of indirectly stimulated muscle in anesthetized man following curarization. Anesthesiology 38:212–223CrossRefPubMedGoogle Scholar
  25. 25.
    Fernando PUE, Viby-Mogensen J, Bonsu AK, Tamilarasan A, Muchhal KK, Lambourne A (1987) Relationship between posttetanic count and response to carinal stimulation during vecuronium induced neuromuscular blockade. Acta Anaesthesiol Scand 31: 593–596CrossRefPubMedGoogle Scholar
  26. 26.
    Fiacchino F, Gemma M, Bricchi M, Giombini S, Regi B (1991) Sensitivity to curare in patients with upper and lower motor neurone dysfunction. Anaesthesia 46:980–982CrossRefPubMedGoogle Scholar
  27. 27.
    Gerber HR, Johansen SH, Mortimer JT, Yodlowski E (1977) Frequency sweep electromyogram and voluntary effort in volunteers after d-tubocurarine. Anesthesiology 46: 35–39CrossRefPubMedGoogle Scholar
  28. 28.
    Harper NJN, Bradshaw EG, Healy TEJ (1986) Evoked electromyographic and mechanical responses of the adductor pollicis compared during the onset of neuromuscular blockade by atracurium or alcuronium, and during anatgonism by neostigmine. Br J Anaesth 58:1278–1284CrossRefPubMedGoogle Scholar
  29. 29.
    Harper NJN, Martlew R, Strang T, Wallace M (1994) Monitoring neuromuscular block by acceleromyography: comparison of the Mini-Accelograph with the Myograph 2000. Br J Anaesth 72:411–414CrossRefPubMedGoogle Scholar
  30. 30.
    Harrison GG (1978) Death attributable to anaesthesia. Br J Anaesth 50:1041–1046CrossRefPubMedGoogle Scholar
  31. 31.
    Heier T, Caldwell JE, Sessler DI, Kitts JB, Miller RD (1989) The relationship between adductor pollicis twitch tension and core skin, and muscle temperature during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology 71:381–384CrossRefPubMedGoogle Scholar
  32. 32.
    Heier T, Caldwell J, Sessler DI, Miller RD (1991) Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia. Anesthesiology 74:815–819CrossRefPubMedGoogle Scholar
  33. 33.
    Heisterkamp DV, Skovsted P, Cohen PJ (1969) The effects of small incremental doses of d-tubocurarine on neuromuscular transmission in anesthetized man. Anesthesiology 30:500–505CrossRefPubMedGoogle Scholar
  34. 34.
    Iwasaki H, Igarashi M, Yamakage M, Omote K, Namiki A (1992) Influence of cardiac output on the onset of neuromuscular blockade after vecuronium. Anesthesiology 77: A945 (Suppl)CrossRefGoogle Scholar
  35. 35.
    Katz RL (1971) Clinical neuromuscular pharmacology of pancuronium. Anesthesiology 34:550–556CrossRefPubMedGoogle Scholar
  36. 36.
    Kopman AF, Lawson D (1984) Milliamperage requirements for supramaximal stimulation of the ulnar nerve with surface electrodes. Anesthesiology 61:83–85PubMedGoogle Scholar
  37. 37.
    Kraynack BJ, Lawson NW, Gintautas J (1983) Neuromuscular blocking action of verapamil in cats. Can Anaesth Soc J 30:242–247CrossRefPubMedGoogle Scholar
  38. 38.
    Lee C, Katz RL (1980) Neuromuscular pharmacology: a clinical update and commentary. Br J Anaesth 52:173–188CrossRefPubMedGoogle Scholar
  39. 39.
    Lunn JN, Hunter AR, Scott DB (1983) Anaesthesia-related surgical mortality Anaesthesia 38:1090–1096CrossRefPubMedGoogle Scholar
  40. 40.
    Meretoja OA, Taivainen T, Brandom BW, Wirtavuori K (1994) Frequency of train-of-four stimulation influences neuromuscular response. Br J Anaesth 72:686–687CrossRefPubMedGoogle Scholar
  41. 41.
    Pavlin E, Holle RH, Schoene RB (1989) Recovery of airway protection compared with ventilation in humans after paralysis with curare. Anesthesiology 70:381–385CrossRefPubMedGoogle Scholar
  42. 42.
    Pedersen T, Viby-Mogensen J, Bang U, Olsen NV, Jensen E, Engbaek J (1990) Does perioperative tactile evaluation of the train-of-four response influence the frequency of postoperative residual neuromuscular blockade? Anesthesiology 73:835–839CrossRefPubMedGoogle Scholar
  43. 43.
    Petersen RS, Bailey PL, Kalameghan R, Ashwood ER (1993) Prolonged neuromuscular block after mivacurium. Anesth Analg 76:194–196CrossRefPubMedGoogle Scholar
  44. 44.
    Sayson S, Mongan PD (1994) Onset of action of mivacurium chloride. A comparison of neuromuscular blockade monitoring at the adductor pollicis and the orbicularis oculi, Anesthesiology 81:35–42CrossRefPubMedGoogle Scholar
  45. 45.
    Secher NH, Ruber N, Secher O (1982) Effect of tubocurarine on human soleus and gastrognemius muscles. Acta Anaesthesiol Scand 26:231–236CrossRefPubMedGoogle Scholar
  46. 46.
    Segredo V, Caldwell JE, Matthay MA, Sharma ML, Gruenke LD, Miller RD (1992) Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med 327:524–528CrossRefPubMedGoogle Scholar
  47. 47.
    Sopher MJ, Sears DH, Walts LF (1988) Neuromuscular function monitoring comparing the flexor hallucis brevis and adductor pollicis muscles. Anesthesiology 69:129–131CrossRefPubMedGoogle Scholar
  48. 48.
    Silverman DG, Connelly NR, O’Connor TZ, Garcia R, Brull S (1992) Accelographic train-of-four at near-threshold currents. Anesthesiology 76:34–38CrossRefPubMedGoogle Scholar
  49. 49.
    Stiffel P, Hameroff SR, Blitt CD, Cork RC (1980) Variability in assessment of neuromuscular blockade. Anesthesiology 52:436–437CrossRefPubMedGoogle Scholar
  50. 50.
    Thornberry EA, Mazumdar B (1988) The effect of changes in arm temperature on neuromuscular monitoring in the presence of atracurium blockade. Anaesthesia 43: 447–449CrossRefPubMedGoogle Scholar
  51. 51.
    Ueda N, Muteki T, Tsuda H, Inoue S, Nishina H (1991) Is the diagnosis of significant residual neuromuscular blockade improved by using double-burst nerve stimulation? Eur J Anaesthesiol 8:213–218PubMedGoogle Scholar
  52. 52.
    Viby-Mogensen J (1982) Clinical assessment of neuromuscular transmission. Br J Anaesth 54:209–223CrossRefPubMedGoogle Scholar
  53. 53.
    Viby-Mogensen J (1984) Monitoring of neuromuscular block in New developments in neuromuscular relaxant drugs. Boerhaave Committee for Postgraduate Medical Education, Faculty of Medicine, Univ LeidenGoogle Scholar
  54. 54.
    Viby-Mogensen J, Howardy-Hansen P, Chraemmer-Jorgensen B, Ording H, Engbaek J, Nielsen AA (1981) Post-tetanic count (PTC): A new method of evaluating intense neuromuscular blockade. Anesthesiology 55:458–461CrossRefPubMedGoogle Scholar
  55. 55.
    Viby-Mogensen J, Jensen NH, Engbaek J, Ording H, Skovgaard LT, Chraemmer-Joergensen B (1985) Tactile and visual evaluation of the response to train-of-four stimulation. Anesthesiology 63:440–443CrossRefPubMedGoogle Scholar
  56. 56.
    Viby-Mogensen J, Jensen E, Werner M, Kirkegaard Nielsen H (1988) Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand 32:45–48CrossRefPubMedGoogle Scholar
  57. 57.
    Viby-Mogensen J, Jorgensen BC, Ording H (1979) Residual curarization in the recovery room. Anesthesiology 50:539–541CrossRefPubMedGoogle Scholar
  58. 58.
    Waud BE, Waud DR (1971) The relation between tetanic fade and receptor occlusion in the presence of competitive neuromuscular block. Anesthesiology 35:456–464CrossRefPubMedGoogle Scholar
  59. 59.
    Waud BE, Waud DR (1972) The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology 37:417–422CrossRefPubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1995

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  • H. Gerber

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