Canadian Journal of Anaesthesia

, Volume 42, Issue 1, pp 21–27 | Cite as

Comparison of tactile and mechanomyo-graphical assessment of response to double burst and train-of-four stimulation during moderate and profound neuromuscular blockade

  • Hans Kirkegaard-Nielsen
  • Hans Søren Helbo-Hansen
  • Inge Krogh Severinsen
  • Peter Lindholm
  • Henrik Stougaard Pedersen
  • Michael Braüner Schmidt
Reports of Investigation

Abstract

It is common clinical practice to estimate the degree of neuromuscular blockade by tactile evaluation of twitch responses. The aim of the present study was to evaluate the use of tactile responses of adductor pollicis to double-burst stimulation (DBS) and train-of-four (TOF) peripheral nerve stimulation for monitoring moderate and profound levels of neuromuscular blockade. The study comprised 44 women scheduled for gynaecological laparotomy and anaesthetised with midazolam, fentanyl, thiopentone, halothane, nitrous oxide and atracurium. The tactile responses of the adductor pollicis were compared with mechanomyographical measurements in the contra lateral arm during recovery from neuromuscular blockade. The observers (anaesthetic nurses) of the tactile responses were blinded with regard to the stimulation pattern and the mechanomyo-graphical measurements. The time from injection of the initial dose of atracurium until tactile reappearance of the first twitch in DBS (D1), was 24.6 (0–39.8) min, median (range). This was more rapid than the time until tactile reappearance of the first twitch in TOF (T1) 32.8 (18.–243.4) min (P< 0.05). The median time from tactile reappearance of D1 until T1 recovered to 15% of the control twitch height was longer than the median time from tactile reappearance of T1 (14.6 versus 10.5 min) (P < 0.05). One or two responses to DBS or TOF were often felt before any responses had been detected mechanomyographically in the contralateral arm. When three or four responses to TOF were felt, responses were always detected mechanomyographically. It is concluded that tactile evaluation of responses to DBS stimulation can estimate deeper levels of blockade than tactile evaluation of responses to TOF.

Key words

measurement techniques: neuromuscular blockade, mechanomyography, double-burst stimulation, train-of-four neuromuscular relaxants: atracurium 

Résumé

En pratique, on détermine le degré curarisation par l’appré-ciation tactile du twitch. Cette étude vise à évaluer l’utilisation de la réponse tactile de l’adducteur du pouce à la stimulation d’un nerf périphérique au double burst (DBS) et au train de quatre (TOF) pour le monitorage des niveaux profonds et modérés de bloc neuromusculaire. Quarante-quatre femmes programmées pour une laparoscopie gynécologique et anesthésiées au midazolam, fentanyl, thiopentone, halothane, protoxyde d’azote et atracurium sont incluses dans l’étude. La réponse tactile de l’adducteur du pouce est comparée avec la réponse mécanomyographique du côté contralatéral pendant la récupération du bloc. Les observatrices (infirmières anesthésistes) ne sont pas au courant du mode de stimulation, ni des mesures mécanomyographiques. L’intervalle entre la dose initiale d’atracurium et la réapparition tactile du premier twitch sur le DBS (D1) est pour la médiane (étendue des valeurs) de 24,6 (0–39,8) min. Cet intervalle est plus court que celui mesuré entre la réapparition tactile du premier twitch au TOF (T1) 32,8 (18,2–43,4) min (P < 0,05). La médiane de l’intervalle entre la réapparition tactile de D1 et la récupération de T1 à 15% du contrôle est plus grande que celle de l’intervalle qui s’étend jusqu’à la réapparition de T1 (14,6 vs 10,5) min (P < 0,05). Une ou deux réponses au DBS ou au TOF sont souvent perçues avant qu’une réponse mécanomyographique ne soit enregistrée du côté controlatéral. Quand trois ou quatre réponses au TOF sont décelées, ces réponses sont toujours enregistrables par mécanomyographie. Pour conclure, l’évaluation tactile des réponses aux DBS peut déceler des niveaux de curarisation plus profonds que l’appréciation tactile des réponses au TOF.

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Copyright information

© Canadian Anesthesiologists 1995

Authors and Affiliations

  • Hans Kirkegaard-Nielsen
    • 1
  • Hans Søren Helbo-Hansen
    • 1
  • Inge Krogh Severinsen
    • 1
  • Peter Lindholm
    • 1
  • Henrik Stougaard Pedersen
    • 1
  • Michael Braüner Schmidt
    • 1
  1. 1.Department of Anaesthesiology and Intensive CareOdense University HospitalDenmark

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