Canadian Journal of Anaesthesia

, Volume 37, Issue 3, pp 307–312 | Cite as

Correlation between integrated evoked EMG and respiratory function following atracurium administration in unanaesthetized humans

  • M. D. Sharpe
  • A. M. Lam
  • J. F. Nicholas
  • D. C. Chung
  • R. Merchant
  • W. Alyafi
  • R. Beauchamp
Reports of Investigation

Abstract

In six healthy volunteers, integrated evoked electromyography (IEEMG) measured in response to ulnar nerve stimulation was correlated with respiratory function — tidal volume (VT), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum negative inspiratory pressure (NIP), hand grip (HG) and head-lift during steady-state infusion of sub-paralytic doses of atracurium. Studies were carried out at train-of-fourT4/T1 = 0.2 and T4/T1, = 0.6. When T4/T1 =0.2, all subjects had difficulty with swallowing and phonation, none could sustain any head-lift and HG was 26 per cent of control. However, VT was normal, FVC was 80 per cent, FEV1 was 82 per cent, and NIP was 50 per cent of control. AT T4/T1 =0.6, all assessments of peripheral strength were normal, and all respiratory measurements were not significantly different from control, except for NIP which was 73 per cent of control (P < 0.05). We conclude that an IEEMG of 0.6, recorded from the hypothenar muscles, in unanaesthetized subjects is consistent with near normal respiratory function.

Key words

measurement techniques: electromyography neuromuscular relaxants: atracurium lung: function, inspiratory pressure, FVC 

Résumé

Pendant une perfusion d’atracurium, nous avons mesuré simultanément, la réponse électromyographique (IEEMG) à une stimulation du nerf cubital, le volume courant (VC), la capacité vitale (CV), le volume expiratoire maximal en une seconde (VEMS), la pression inspiratoire négative maximale (PINM), la force de préhension (FP) et l’élévation de la tête de six volontaires bien portant. Lorsque le T4/T1 du train-de-quatre était de 0,2, tous avaient des problèmes de déglutition et d’élocution, aucun ne pourvait garder la tête levée et la FP n’équivalait qu’ à 26 pour cent de sa valeur contrôle. Pourtant le Vc était normal, et la CV était à 80 pour cent, le VEMS à 82 pour cent et la PINM à 50 pour cent du contrôle. Avec un T4/T1 de 0,6, la force des muscles périphériques était normale de même que les mesures de mécanique respiratoire sauf la PINM, à 73 pour cent du contrôle. Donc, avec un IEEMG de 0,6 à l’éminence hypothénar, la fonction respiratoire des sujets conscients est quasiment normale.

References

  1. 1.
    Walts LF, Levin N, Dillon JB. Assessment of recovery from curare. JAMA 1970; 213: 1894–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Bendixen HH, Surtees AD, Oyama T, Bunker J-P. Postoperative disturbances in ventilation following the use of muscle relaxants in anesthesia. Anesthesiology 1959; 20: 121–2.CrossRefGoogle Scholar
  3. 3.
    Ali HH. A new device for monitoring force of thumb ad-duction. Br J Anaesth 1970; 42: 83–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block (Part 1). Br J Anaesth 1971; 43: 473–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Churchill-Davidson HC, Christie TH. The diagnosis of neuromuscular block in man. Br J Anaesth 1959; 31: 290–301.PubMedCrossRefGoogle Scholar
  6. 6.
    Katz RL. A nerve stimulator for the continous monitoring of muscle relaxant action. Anesthesiology 1965; 26: 832–3.PubMedGoogle Scholar
  7. 7.
    Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block (Part II). Br J Anaesth 1971; 43: 478–85.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee CM. Train-of-4 quantitation of competitive neuromuscular block. Anesth Analg 1975; 54: 649–53.PubMedGoogle Scholar
  9. 9.
    Viby-Mogensen J. Clinical assessment of neuromuscular transmission. Br J Anaesth 1982; 54: 209–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Carter JA, Arnold R, Yate PM, Flynn PJ. Assessment of the Datex relaxograph during anaesthesia and atracurium-induced neuromuscular blockade. Br J Anaesth 1986; 58: 1447–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Lam HS, Cass NM, Ng KC. Electromyographic monitoring of neuromuscular block. Br J Anaesth 1981; 53: 1351–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Pugh ND, Kay B, Healy TEJ. Electromyography in anaesthesia. Anaesthesia 1984; 39: 574–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Kopman AF. The relationship of evoked electromyographic and mechanical responses following atracurium in humans. Anesthesiology 1985; 63: 208–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Weber S, Muravchick S. Electrical and mechanical train-of-four responses during depolarizing and non-depolarizing neuromuscular blockade. Anesth Analg 1986; 65: 771–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Helewa, A, Goldsmith CH, Smythe HA. The modified sphygmomanometer — an instrument to measure strength: a validation study. J Chronic Dis 1981; 34: 353–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Bar ZG. The armlift test. Anaesthesia 1985; 40: 630–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Gal TJ, Goldberg SK. Diaphragmatic function in healthy subjects during partial curarization. J Appl Physiol 1980; 48: 921–6.PubMedGoogle Scholar
  18. 18.
    Gal TJ, Arora NS. Respiratory mechanics in supine subjects during progressive partial curarization. J Appl Physiol 1982; 52: 57–63.PubMedGoogle Scholar
  19. 19.
    DeTroyer A, Bastenier J, Delhez L. Function of respiratory muscles during partial curarization in humans. J Appl Physiol 1980; 49: 1049–56.Google Scholar
  20. 20.
    Rosenbaum SH, Askanazi J, Hymann AL, Kinney JM. Breathing patterns during curare-induced muscle weakness. Anesth Analg 1983; 62: 809–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Foldes FF, Monte AP, Brunn HM, Wofson B. Studies with muscle relaxants in unanaesthetized subjects. Anesthesiology 1961; 22: 230–6.PubMedGoogle Scholar
  22. 22.
    Waud BE, Waud DR. The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology 1971; 37: 417–22.CrossRefGoogle Scholar
  23. 23.
    Wymore ML, Eisele JH. Differential effects of d-tubocurarine on inspiratory muscles and two peripheral muscle groups in anesthetized man. Anesthesiology 1978; 48: 360–2.PubMedCrossRefGoogle Scholar
  24. 24.
    Viby-Mogensen J, Jorgensen BC, Ording H. Residual curarization in the recovery room. Anesthesiology 1972; 37: 417–22.Google Scholar
  25. 25.
    Ali HH, Savarese JJ, Lebowitz PW, Ramsey FM. Twitch, tetanus, and train-of-four as indices of recovery from nondepolarizing neuromuscular blockade. Anesthesiology 1981; 54: 294–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four muscle responses and respiratory measurements in humans. Br J Anaesth 1975; 47: 570–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Brand JB.Cullen DJ, Wilson NE, Ali HH. Spontaneous recovery from non-depolarizing neuromuscular blockade: correlation between clinical and evoked responses. Anesth Analg 1977; 56: 55–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Ali HH, Kitz RJ. Evaluation of recovery from non-depolarizing neuromuscular block, using digital ncuromuscular transmission analyzer: preliminary report. Anesth Analg 1973; 52: 740–4.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Donati F, Bevan JC, Bevan DR. Neuromuscular blocking drugs in anaesthesia. Can Anaesth Soc J 1984; 31: 324–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Katz RL. Elcctromyographic and mechanical effects of suxamethonium and tubocurarine on twitch, tetanic and post-tetanic responses. Br J Anaesth 1973; 45: 849–59.PubMedCrossRefGoogle Scholar
  32. 32.
    Gal TJ, Goldberg SK. Relationship between respiratory muscle strength and vital capacity during partial curarization in awake subjects. Anesthesiology 1981; 54: 141–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Johansen SH, Jorgensen M, Molbech S. Effect of tubocurarine on respiratory and non-respiratory muscle power in man. J Appl Physiol 1964; 19: 990–4.PubMedGoogle Scholar
  34. 34.
    Pavlin EG, Holle RH, Schoene RB. Recovery of airway protection compared with ventilation in humans after paralysis with curare. Anesthesiology 1989; 70: 381–5.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1990

Authors and Affiliations

  • M. D. Sharpe
    • 1
    • 2
  • A. M. Lam
    • 1
    • 2
  • J. F. Nicholas
    • 1
    • 2
  • D. C. Chung
    • 1
    • 2
  • R. Merchant
    • 1
    • 2
  • W. Alyafi
    • 1
    • 2
  • R. Beauchamp
    • 1
    • 2
  1. 1.Department of Anaesthesia, St. Joseph’s HospitalUniversity of Western OntarioLondonCanada
  2. 2.Department of AnesthesiologyUniversity of WashingtonSeattle

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