Abstract
The study was undertaken in order to determine clinical tactile evaluation of tetanic nerve stimulation (50 Hz, 5 sec) as a means of detecting fade and possible residual curarization. Forty-four patients were studied and 128 clinical evaluations by eight different observers were performed at various levels of neuro-muscular blockade. Tetanic fade was detected reliably by clinical evaluation only when high degrees of fade (tetanic fade ratio of 0.3 or less) were detected with a force-displacement transducer. We conclude that the clinical tactile assessment of the response to tetanic stimulation is not accurate except at very high degrees of fade and that its usefulness in monitoring neuromuscular recovery is doubtful.
Résumé
La présente étude avail pour but de justifier l’évaluation tactile clinique de la réponse à la stimulation tétanique (50 Hz, 5 sec) comme moyen de détection d’un affaiblissement à cette stimulation télanique et d’une curarisation résiduelle possible. Quarantequatre patients ont étée étudiés et soumis à 128 évaluations cliniques de l’affaiblissement à la stimulation tétanique par huit observateurs différents, et ce à divers niveaux de bloc neuro-musculaire. L’affaiblissement tétanique n’a été détecté par i évaluation clinique que lorsque de hauls niveaux d’affaiblissement étaient objectivés au transducteur de force (rapport d’affaiblissement tétanique de 0,3 ou moins). Nous concluons que l’évaluation clinique tactile de la réponse à la stimulation tétanique n’est pas un moyen efficace de détection de l’affaiblissement tétanique et que son utilité comme moyen de monitorage de la récupération neuromusculaire peut être mise en doute.
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References
Churchill-Davidson HC. A portable peripheral nerve-stimulator. Anesthesiology 1965; 26: 224–6.
Katz RL. A nerve stimulator for the continuous monitoring of muscle relaxant action. Anesthesiology 1965; 26: 832–3.
Walts LF, Levin N, Dillon JB. Assessment of recovery from curare. JAMA 1970; 213: 1894–6.
Viby-Mogensen J. Clinical assessment of neuromuscular transmission. Br J Anaesth 1982; 54: 209–23.
Jones RM. Neuromuscular transmission and its blockade. Anaesthesia 1985; 40: 964–76.
Walts LF. Evaluation of recovery from nondepolarizing neuromuscular block, using a digital neuromuscular transmission analyzer: preliminary report. Guest discussion. Anesth Analg 1973; 52: 744–5.
Viby-Mogensen J, JensenNH, Engbaek J, Ording H, Skovgaard LT, Chraemmer-Jorgensen B. Tactile and visual evaluation of the response to train-of-four stimulation. Anesthesiology 1985; 63: 440–3.
Merton PA. Voluntary strength and fatigue. J Physiol 1954; 123: 553–64.
Stanec A, Heyduk J, Stanec G, Orkin LR. Tetanic fade and post-tetanic tension in the absence of neuromuscular blocking agents in anesthetized man. Anesth Analg 1978; 57: 102–7.
Miller RD, Eger El II, Way WL, Stevens WC, Dolan WM. Comparative neuromuscular effects of forane and holathane alone and in combination with d-tubocurarine in man. Anesthesiology 1971; 35: 38–42.
Lee C, Barnes A, Katz RL. Neuromuscular sensitivity to tubocurarine. Br J Anaesth 1976; 48: 1045–51.
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.
Ali HH, Kilz RJ. Evaluation of recovery from nondepolarizing neuromuscular block, using a digital neuromuscular transmission analyzer: preliminary report. Anesth Analg 1973; 57: 740–5.
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.
Viby-Mogensen J, Chraemmer-Jorgensen B, Ording H. Residual curarization in the recovery room. Anesthesiology 1979; 50: 539–41.
Beemer GH, Rozental P. Postoperative neuromuscular function. Anaesth Intensive Care 1986; 14: 41–5.
Bevan DR, Smith CE, Donati F. Postoperative neuromuscular blockade: a comparison between atracurium, vecuronium and pancuronium. Anesthesiology 1988; 69: 272–6.
Engbaek J, Ostergaard D, Viby-Mogensen J. Double-burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block. Br J Anaesth 1989; 62: 274–8.
Drenck NR, Ueda N, Olsen NV et al. Manual evaluation of residual curarization using double burst stimulation: a comparison with train-of-four. Anesthesiology 1989; 70: 578–81.
Viby-Mogensen J, Howardy-Hansen P, Chraemmer-Jorgensen B, Ording H, Engbaek J, Nielsen A. Post tetanic count (PTC): a new method of evaluating an intense nondepolarizing neuromuscular blockade. Anesthesiology 1981; 55: 458–61.
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Dupuis, J.Y., Martin, R., Tessonnier, J.M. et al. Clinical assessment of the muscular response to tetanic nerve stimulation. Can J Anaesth 37, 397–400 (1990). https://doi.org/10.1007/BF03005614
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DOI: https://doi.org/10.1007/BF03005614