Abstract
Purpose
We present a new stimulating pattern: double burst stimulation2,3 (DBS2,3) for evaluating residual neuromuscular block.
Methods
Forty adult patients were studied. For DBS2,3, two burst stimuli were applied every 750 msec. The first consisted of two tetanic stimuli of 0.2 msec duration and the second of three tetanic stimuli of 0.2 msec duration. At varying degrees of neuromuscular block induced by vecuronium, the presence or absence of fade, or the presence or absence of waxing (i.e., the feeling that the muscular contraction in response to the second burst was stronger than that to the first) was determined by an observer blinded to the depth of neuromuscular block. In addition, the relationship between the train-of-four (TOF) ratio and DBS2,3 ratio was established at varying depths of neuromuscular block (TOF ratio 0.04–1.00).
Results
The probabilities of tactile detection of fade in response to DBS2,3 were 100, 76, 15, 9, 3, 0, and 0% at a TOF ratio of 0–0.40, 0.41–0.50, 0.51–0.60, 0.61–0.70, 0.71–0.80, 0.81–0.90, and 0.91–1.00, respectively. Waxing in response to the DBS2,3 was identified in 0, 6, 32, 84, and 98% of cases when the TOF ratios were 0.00–0.60, 0.61–0.70, 0.71–0.80, 0.81–0.90, and 0.91–1.00, respectively. A close linear relationship existed between the TOF ratio and DBS2,3 ratio (r = 0.96, P < 0.000001).
Conclusion
DBS2,3 is of clinical use because when residual neuromuscular block is clinically important, fade can be identified, but once neuromuscular function returns to a sufficient level, waxing can be detected.
Résumé
Objectif
Les auteurs présentent un nouveau mode de stimulation, le double burst 2,3 (DBS2,3) pour évaluer ta curarisation résiduelle.
Méthodes
L’étude portait sur 40 adultes. Pour le DBS2,3, deux stimuli ont été appliqués aux 750 msec. Le premier était formé de deux stimuli tétaniques de 0,2 msec et le second de trois stimuli tétaniques de 0,2 msec. A différents niveaux de curarisation au vécuronium, la présence ou l’absence de fade (fatigue) et l’absence de waxing (impression que la concentration musculaire en réponse à la deuxième stimulation était plus importante que la première) étaient évaluées par un observateur ignorant la profondeur du bloc neuromusculaire. En outre, la relation entre le ratio du train-de-quatre (TOF) et le ratio du DBS2,3 a été établie à différents niveau de curarisation.
Résultats
Les probabilités de détection du fade en réponse au DBS2,3 étaient de 100, 76, 15, 9, 3 et 0% à des ratios de TOF respectifs de 0,00–0,40, 0,41–0,50, 0,51–0,60, 0,61–0,70, 0,71–0,80, 0,81–0,90, et 0,91–1,00. Le waxing en réponse au DBS2,3 étaient identifié dans 0, 6, 32, 84, et 98% des cas à des ratios respectifs de TOF de 0,00–0,60, 0,61–0,70, 0,71–0,80, 0,81–0,90, et 0,91–1,00. Il existait une relation linéaire étroite entre le ratio du TOF et le ratio du DBS2,3 (r = 0,96, P < 0,000001).
Conclusion
Le DBS2,3 est utile en clinique parce qu’on peut identifier le fade quand la curarisation résiduelle est importante cliniquement; lorsque la fonction neuromusculaire revient à un niveau adéquat, on peut aussi détecter le waxing.
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Saitoh, Y., Nakazawa, K., Tanaka, H. et al. Double burst stimulation2,3: a new stimulating pattern for residual neuromuscular block. Can J Anaesth 43, 1001–1005 (1996). https://doi.org/10.1007/BF03011900
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DOI: https://doi.org/10.1007/BF03011900