Canadian Journal of Anaesthesia

, Volume 43, Issue 4, pp 362–367 | Cite as

Recovery of post-tetanic and train-of-four responses at the first dorsal interosseous and adductor pollicis muscles in patients receiving vecuronium

  • Yuhji Saitoh
  • Hiroyoshi Tanaka
  • Hidenori Toyooka
  • Keisuke Amaha
Reports of Investigation

Abstract

Purpose

To compare recovery of accelographical responses to post-tetanic twitch (PTT) and train-of-four (TOF) stimuli obtained at the first dorsal interosseous muscle (DI) with those at the adductor pollicis muscle (AP) after administration of vecuronium 70 μg · kg−1.

Methods

Sixty adult patients were randomly assigned to one of four groups: PTT-DI (n = 15), PTT-AP (n = 15), TOF-DI (n = 15), or TOF-AP (n = 15) group. In PTT-DI and PTT-AP groups, responses to PTT were measured accelographically at the DI and at the AP, respectively. In TOF-DI and TOF-AP groups, responses to TOF were measured at the DI and at the AP, respectively.

Results

The T1/T0 (T0 = control) was greater in the TOF-DI than in TOF-AP group throughout recovery (P < 0.05), and the T4/T1 was greater in the TOF-DI than in TOF-AP group during the 30–40 min after vecuronium injection (P < 0.05). Time to the return of the first response to PTT (post-tetanic count1, PTC1) was less in the PTT-DI than in the PTT-AP group (17.7 ± 4.2 vs 21.7 ± 5.6 min, mean ± SD, P = 0.0341). The post-tetanic count PTC (number of single twitch stimuli in response to PTT) was greater in the PTT-DI than in the PTT-AP group during the 10–30 min after vecuronium (P < 0.05). Time to the return of T1 was less in the TOF-DI than in the TOF-AP group (23.1 ± 6.0 vs 27.6 ± 4.9 min, P = 0.0334).

Conclusion

Recovery of responses to PTT and TOF stimuli occurred earlier at the DI than at the AP.

Key words

monitoring: post-tetanic twitch, train-of-four muscle: first dorsal interosseous muscle, adductor pollicis muscle neuromuscular relaxants: vecuronium 

Résumé

Objectif

Comparer la récupération des réponses accélerographiques du twitch post-tétanique (PTT) et du train-de-quatre (TOF) mesurées au niveau du premier muscle interosseux dorsal (DI) à celles du muscle adducteur du pouce (AP) après l’administration de vécuronium 70 μg · kg−1.

Méthodes

Soixante patients d’âge adulte ont été répartis aléatoirement à un de quatre groupes: PTT-DI (n = 15), PTT-AP (n = 15), TOF-DI (n = 15) et TOF-AP (n = 15). Dans les groupes PTT-DI et PTT-AP, les réponses au PTT ont été mesurées par accélérographie respectivement au DI et à l’AP. Dans les groupes TOF-DI et TOF-AP, les réponses au TOF ont été mesurées respectivement au DI et à l’AP.

Résultats

Le T1/T0 (T0 = valeur de contrôle) a été plus élevé dans le groupe TOF-DI que dans le groupe TOF-AP pendant la récupération (P < 0,05) et le T4/T1 dans le groupe TOF-DI a été plus élevé que dans le groupe TOF-AP pendant les 30–40 min après l’injection du vécuronium (P < 0,05). Le délai de retour de la première réponse du PTT (le compte post-tétanique1, PTC1 (était plus court dans le groupe PTT-DI que dans le groupe PTT-AP (17,7 ± 4,2 vs 21,7 ± 5,6 min, moyenne ± ET, P = 0,0341). Le compte post-tétanique (le décompte des twitchs isolés en réponse au PTT) du groupe PTT-DI a été plus élevé que dans le groupe PTT-AP pendant les 10–30 min qui ont suivi le vécuronium (P < 0,05). Le délai de retour de T1 dans le groupe TOF-DI a été plus court dans le groupe TOF-DI que dans le groupe TOF-AP (23,1 ± 6,0 vs 27,6 ± 4,9 min, P = 0,0334).

Conclusion

La récupération des réponses aux stimuli du PTT et du TOF est survenue plus rapidement au DI qu ’à l’AP.

References

  1. 1.
    Paton WDM, Zaimis EJ. The action of D-tubocurarine and of decamethonium on respiratory and other muscles of the cat. J Physiol (Lond) 1951; 112: 311–31.Google Scholar
  2. 2.
    Jewell PA, Zaimis EJ. A differentiation between red and white muscle in the cat based on responses to neuromuscular blocking agents. J Physiol (Lond) 1954; 124: 417–28.Google Scholar
  3. 3.
    Secher NH, Rube N, Secher O. Effect of tubocurarine on human soleus and gastrocnemius muscles. Acta Anaesthesiol Scand 1982; 26: 231–4.PubMedGoogle Scholar
  4. 4.
    Johnson MA, Polgar J, Weightman D, Appleton D. Data on the distribution of fibre types in thirty-six human muscles. An autopsy study. J Neurol Sci 1973; 18: 111–29.PubMedCrossRefGoogle Scholar
  5. 5.
    Engbœk J, Roed J. Differential effect of pancuronium at the adductor pollicis, the first dorsal interosseous and the hypothenar muscles. An electromyographic and mechano-myographic dose-response study. Acta Anaesthesiol Scand 1992; 36: 664–9.Google Scholar
  6. 6.
    Harper NJN. Comparison of the adductor pollicis and the first dorsal interosseous muscles during atracurium and vecuronium blockade: an electromyographic study. Br J Anaesth 1988; 61: 477–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Donati F, Meistelman C, Plaud B. Vecuronium neuro-muscular blockade at the diaphragm, the orbicularis oculi, and adductor pollicis muscles. Anesthesiology 1990; 73: 870–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Caffrey RR, Warren ML, Becker KE Jr. Neuromuscular blockade monitoring comparing the orbicularis oculi and adductor pollicis muscles. Anesthesiology 1986; 65: 95–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Debaene B, Meistelman C, Beaussier M, Lienhart A. Visual estimation of train-of-four responses at the orbicularis oculi and posttetanic count at the adductor pollicis during intense neuromuscular block. Anesth Analg 1994; 78: 697–700.PubMedCrossRefGoogle Scholar
  10. 10.
    Debaene B, Beaussier M, Meistelman C, Donati F, Lienhart A. Monitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium-induced neuromuscular block. Anesth Analg 1995; 80: 360–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Derrington MC, Hindocha N. Comparison of neuromuscular blockade in the diaphragm and the hand. Br J Anaesth 1988; 61: 279–85.PubMedCrossRefGoogle Scholar
  12. 12.
    Chauvin M, Lebrault C, Duvaldestin P. The neuromuscular blocking effect of vecuronium on the human diaphragm. Anesth Analg 1987; 66: 117–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Suzuki T, Suzuki H, Katsumata N, Shiraishi H, Saitoh H, Ogawa S. Evaluation of twitch responses obtained from abductor hallucis muscle as a monitor of neuromuscular blockade: comparison with the results from adductor pollicis muscle. Journal of Anesthesia 1994; 8: 44–8.CrossRefGoogle Scholar
  14. 14.
    May O, Kirkegaard Nielsen H, Werner MU. The acceleration transducer –an assessment of its precision in comparison with a force displacement transducer. Acta Anaesthesiol Scand 1988; 32: 239–43.PubMedGoogle Scholar
  15. 15.
    Harper NJN, Martlew R, Strang T, Wallace M. Monitoring neuromuscular block by acceleromyography: comparison of the Mini-Accelograph with the Myograph 2000. Br J Anaesth 1994; 72: 411–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Kirkegaard-Nielsen H, Helbo-Hansen HS, Severinsen IK, Lindholm P, Pedersen HS, Schmidt MB. Comparison of tactile and mechanomyographical assessment of response to double burst and train-of-four stimulation during moderate and profound neuromuscular blockade. Can J Anaesth 1995; 42: 21–7.PubMedGoogle Scholar
  17. 17.
    Silverman DG, Connelly NR, O’Connor TZ, Garcia R, Brull SJ. Accelographic train-of-four at near-threshold currents. Anesthesiology 1992; 76: 34–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Viby-Mogensen J, Jensen E, Werner M, Kirkegaard Nielsen H. Measurement of acceleration: a new method of monitoring neuromuscular function. Acta Anaesthesiol Scand 1988; 32: 45–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lepage JY, Malinovsky JM, Lechevalier T, Cozian A, Pinaud M. Neuromuscular transmission analyser: mechanomyography vs acceleromyography. Anesthesiology 1995; 83: A891.CrossRefGoogle Scholar
  20. 20.
    Nishizawa M, Goto H, Otagiri T, Nakajima N, Harashima N, Sakai J. Effect of prior administration of succinyl-choline on duration of action of vecuronium during enflurane anaesthesia. Acta Anaesthesiol Scand 1994; 38: 380–3.PubMedGoogle Scholar
  21. 21.
    Ono K, Manabe N, Ohta Y, Morita K, Kosaka F. Influence of suxamethonium on the action of subsequently administered vecuronium or pancuronium. Br J Anaesth 1989; 62: 324–6.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Yuhji Saitoh
    • 1
  • Hiroyoshi Tanaka
    • 1
    • 2
  • Hidenori Toyooka
    • 1
  • Keisuke Amaha
    • 1
  1. 1.Department of Anesthesiology and Critical Care Medicine, Faculty of MedicineTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of AnesthesiologyToride Kyodo General HospitalIbarakiJapan

Personalised recommendations